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 Incidence: 50 % of hospitalized patients

 Common causes:
- Hypermetabolic states: Trauma,
Infection, Major surgery, Burn
- Poor nutrition
 Consequences: Weakness, Decreased wound
healing, increased respiratory failure,
decreased cardiac contractility, infections
(pneumonia, abscesses), Prolonged
hospitalization
 Enteral Nutrition ( Physiologic, less expensive)
 Parenteral Nutrition
- GI should not be used (Obstruction,
Pancraitis)
- GI can not be used ( Vomiting, Diarrhea,
Resection of intestine, short bowel syndrome)
 Peripheral Parenteral
Nutrition
 Central Parenteral
Nutrition (TPN)
◦ Needs CV-line to
administer hyperosmolar
solutions
 Harris-Benedict equations:
 BEE (men) (kcal/day): 66.47+13.75W+5H-
6.76A
 BEE (women) (kcal/day): 655.1+9.56W+1.85H-
4.68A
 TEE (kcal/day):
BEE × Stress factor × Activity factor
 Stress factors: Surgery, Infection: 1.2
Trauma: 1.5 Sepsis: 1.6
Burns: 1.6-2
 Activity factors: sedentary: 1.2 , normal
activity: 1.3, active: 1.4 , very active: 1.5
 Normal/mild stress level: 20-25 kcal/kg/day
 Moderate stress level: 25-30 kcal/kg/day
 Severe stress level: 30-40 kcal/kg/day
 Pregnant women in second or third
trimester: Add an additional 300 kcal/day
 5 g/kg/day or 3.5 mg/kg/minute (maximum
rate: 4-7 mg/kg/minute)
 Minimum recommended amount: 400
calories/day or 100 g/day
 Maintenance: 0.8-1 g/kg/day
 Normal/mild stress level: 1-1.2 g/kg/day
 Moderate stress level: 1.2-1.5 g/kg/day
 Severe stress level: 1.5-2 g/kg/day
 Burn patients (severe): Increase protein until
significant wound healing achieved
 Solid organ transplant: Perioperative: 1.5-2
g/kg/day
 Acute (severely malnourished or
hypercatabolic): 1.5-1.8 g/kg/day
 Chronic, with dialysis: 1.2-1.3 g/kg/day
 Chronic, without dialysis: 0.6-0.8 g/kg/day
 Continuous hemofiltration: ≥ 1 g/kg/day
 Initial: 20% to 40 % of total calories
(maximum: 60% of total calories or 2.5
g/kg/day)
◦ Note: Monitor triglycerides while receiving
intralipids.
 Safe for use in pregnancy
 I.V. lipids are safe in adults with pancreatitis
if triglyceride levels <400 mg/dL
Macro:
Calorie: Dextrose 20%, 50%
Intralipid 10%, 20%
Protein: Aminofusion 5%, 10%
Micro:
Electrolytes (Na, K, Mg, Ca, PO4)
Trace elements (Zn, Cu, Cr, Mn,
Se)
 20%, 50% ( from CV-line)
 3.4 kcal/g
 60-70% of calorie requirements
should be provided with dextrose
 Hypersensitivity to corn or corn products
 Hypertonic solutions in patients with
intracranial or intraspinal hemorrhage
 10%, 20% ( from peripheral or CV-
line)
 1.1 kcal/ml (10%), 2 kcal/ml (20%)
 30-40% of calorie requirements
should be provided with Intralipid
1022 Kcal/L
345 mosmol/L
1080 Kcal/L
 Hypersensitivity to fat emulsion or any
component of the formulation; severe egg or
legume (soybean) allergies
 Pathologic hyperlipidemia, lipoid nephrosis,
pancreatitis with hyperlipemia (TG>400
mg/dl)
 5%, 10% ( from CV-line)
 1-1.5 g/kg/day
 Should not be used as a
calorie source
400 Kcal/L 200 kcal/L
1030 mosmol/L 590 mosmol/L
 Hypersensitivity to one or more amino acids
 Severe liver disease or hepatic coma
 Endocrine & metabolic
◦ Fluid overload, hypercapnia, hyperglycemia, hyper-
/hypokalemia, hyper-/hypophosphatemia, refeeding
syndrome
 Hepatic
◦ Cholestasis, cirrhosis (<1%), gallstones, liver function
tests increased, pancreatitis, steatosis, triglycerides
increased
 Renal
◦ Azotemia, BUN increased
 Infectious
◦ Bacteremia, catheter-induced infection, exit-site
infections
 Other: Pneumothorax, Thrombophlebitis
 In patients with long-standing or severe
malnutrition
 Is a medical emergency, consist of:
◦ Electrolyte disturbances (eg, potassium,
phosphorus)
◦ Respiratory distress
◦ Cardiac arrhythmias, resulting in cardiopulmonary
arrest
 Do not overfeed patients; caloric replacement
should match as closely as possible to intake
 Malnutrition is a common problem &
Nutritional support is indicated in many
hospitalized patients
 Enteral nutrition is better, but some patients
with GI problems need TPN
 Dextrose & Intralipid should be used as
calorie sources and Aminofusion as
aminoacid source