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Total parenteral nutrition TPN

Definition. Provision of all nutritions through other than the alimentary tract. Indications. Those who do not eat: anorexia nervosa, Those who can not eat: esophageal stenosis, prolong ileus, Those who are not allowed to eat: gastrointestinal fistula, inflammatory bowel disease, radiation enteritis, GI chemotoxicity, pancreatitis.

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Total parenteral nutrition TPN

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    1. Total parenteral nutrition (TPN) Intern ???

    2. Definition Provision of all nutritions through other than the alimentary tract

    3. Indications Those who do not eat: anorexia nervosa, Those who can not eat: esophageal stenosis, prolong ileus, Those who are not allowed to eat: gastrointestinal fistula, inflammatory bowel disease, radiation enteritis, GI chemotoxicity, pancreatitis

    4. Indications Those who are not eating enough: short bowel syndrome, burn, sepsis Those who can manage what they eat: hepatic failure Others: renal failure, operation

    5. Perioperative parenteral nutrition Predicted weigh loss > 15% Albumin < 3 g per 100 ml Duration: 8~10 days Mortality: not changed, Sandstrom

    6. Complications -- mechanical Catheter infection Pneumothorax Arterial laceration Hemothorax Hydrothorax Nerve injury: brachial plexus or its branches, phrenic nerve, recurrent laryngeal

    7. Complications -- mechanical Air embolism Catheter embolism Thoracic duct injury Venous embolism, perforation Sepsis

    8. Complications -- metabolic Hyperglycemia Rapid initiation of the infusion Pancreatic insufficiency (more common in elderly) Pancreatitis Liver disease Sepsis

    9. Complications -- metabolic Hypoglycemia Slowing of the infusion Excessive insulin administration Endogenous overproduction of insulin Hyperosmolar hyperglycemic nonketotic comafever: dizziness, osmotic diuresis, blood sugar of 700~1400 mg/dl

    10. Complications -- metabolic Fluid overload Electrolytes abnormality Acid-base imbalances Trace mineral deficiency

    11. Complications -- metabolic Liver function derangement Elevated AST, ALT levels Hyperbilirubinemia: rare, related to sepsis Hepatic steatosis: almost all components of parenteral nutrition Excessive glucose adminstration, translocation of bacteria and their products such as endotoxin

    12. Complications First 48 hrs: catheter insertion First 2 weeks: Thrombosis 3 months: Fractures or tears in catheter, catheter embedded in vein wall

    13. Complications First 48 hrs: Fluid overload, hyperglycemia First 2 weeks: Cardiopulmonary failure, HHNK, electrolyte imbalabce 3 months: TPN liver disease, Zinc, copper, chromium, selenium, molybdenum, deficiency

    14. Postabsorptive state Interprandial

    15. Bypass theory Decreased first pass clearance of amino acid, glucose, and insulin Increased de novo lipogenesis of liver

    16. Cyclic TPN Mobility Establish a more metabolic and hormonal profile: insulin, glucagon, GH, thyroid hormone Miani et al.: change of hormonal profile decreased at 2~3 weeks, similar sepsis rate Lerebours et al.: similar nitrogen balance after 1 week

    17. Thanks !!

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