Sunday, March 15, 2015
NUTRITION
Caloric requirement in adults – 40kcal/kg/day
Carbohydrates 50% , fat 30-40% and protein 10-15%
Caloric value- carbohydrate and protein - 4kcal/g and fat – 9kcal/g
Indications of nutritional supplementation
- Preoperative nutritional depletion
- Burns
- Trauma
- Anorexia nervosa and intractable vomiting
- Pancreatitis, malabsorption, ulcerative colitis, pyloric stenosis
- High output intestinal fistulas
- Postoperative complications like sepsis, ileus and fistula
- Malignant disease
Methods of feeding
Enteral feeding
- GI tract is the best route to provide nutrition.
- Can be done
ii.By nasogastric tube
iii.By enterostomy e.g. gastrostomy and jejunostomy in severe malnutrition, major surgeries, severe sepsis
Total parenteral nutrition (TPN)
Indications:
- Failure or contraindication for any enteral nutrition
- High output intestinal fistulas
- Major abdominal surgery of liver, pancreas, biliary tract, colon
- Septicemia
- Multiple trauma
- Short bowel syndrome
- TPN is given through central vein and not through peripheral vein
- Components used in TPN – carbohydrates, fat, aminoacids, vitamins and trace elements
- Contraindications :
- Cardiac failure
- Blood dyscrasias
- Altered fat metabolism
1.Due to placement of CVP
- Air embolism
- Pneumothorax
- Bleeding
- Infection
- Catheter displacement, sepsis, blockage, thrombosis
- Electrolyte imbalance
- Hyperglycemia
- Hyperosmolarity
- Dehydration
- Azotemia
- Altered immunological function
- Dermatitis
- Anemia
- Cholestatic jaundice.
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