Nutrition

• Avoid malnutrition (morbidity, delayed recovery, and increased respiratory complications)
• Enteral route is preferred
• Avoid overfeeding
• Timing is important
• Nutrition therapy reduces protein wasting

• Neonates: 100 kcal/kg
• Adult: 40 kcal/kg

• Pre-op. Nutrition depletion
• Post-op. Complications
• Intestinal fistula - high output type
• Pancreatitis, Ulcerative colitis, Malabsorption
• Anorexia
• Trauma
• Massive Bowel resection

• Body weight
• Triceps skin fold thickness
• Lymphocyte count
• Mid arm circumference
• Serum albumin

• Mouth
• NG Tube
• Enterostomy (gastrostomy, jejunostomy)

• Preserve mucosal protein
• Physiologic
• Less complications

• Ileus
• Intestinal obstruction
• GIT Bleeding
• Hemodynamically unstable

All nutrition requirements are given through intravenous route (Central: subclavian/IJV, Peripheral vein).

Indications for TPN

• Failure of enteral feeding
• High output fistula
• Major abdominal surgeries (e.g., hepatic resections)
• Septicemia
• Severe pancreatitis
• Massive GI Bleeding
• High-risk aspiration
• Hyperemesis gravidarum
• Multiple Organ Failure
• Burns
• Head injury

Goals in TPN

• To reduce adverse effects of catabolism
• To increase protein synthesis
• To prevent weight loss
• Support ongoing anabolism
• To improve hormone function
• To maintain glycogen reserve
• To maintain acid-base balance

Components of TPN

• Carbohydrates
• Fats
• Proteins
• Vitamins
• Electrolytes
• Trace elements
• Minerals

Complications of TPN

Technical

• Air embolism
• Pneumothorax
• Bleeding
• Catheter displacement/blockage
• Sepsis
• Thrombosis

Biochemical

• Hypokalemia
• Hyponatremia
• Hypophosphatemia
• Hyperosmolality
• Hyperglycemia
• Dehydration
• Metabolic acidosis

Other Complications

• Altered immunologic function
• Cholestatic jaundice
• Anemia
• Candidiasis