Academic Day Seminars

ADS – TPN

Yesterday we had a great ADS about pediatric TPN with the PICU dietician, Parveen. I was glad to have a refresher on all things TPN (I had a bit of a crash course in it during my distribution rotation). Some things to remember:

  • If the gut works, use it!
  • BMR: basal metabolic rate (how much you burn just sitting/lying down)
    • Adults: 20 calories/kg
    • Children: 60-70 calories/kg
    • Infants: 70-80 calories/kg
      • 1/3 of what children eat goes towards growth
  • Requirements for growth: 30kcal/kg for growth

When do we start TPN?

  • 1 day for preterm neonate
  • 4 days for high risk infant
  • 5-7 days for older children

Components of TPN

  • Carbohydrates: 3.4 kcal/g of dextrose which should make up ~ 45-60% of total calories
  • Protein: 4 kcal/g of free amino acids buffered with acetate or chloride which should provide 8-15% of total calories
  • Fats: 2 kcal/mL (10kcal/g) which should provide 25-35% of total calories. Provided as intralipi 20% or SMOF
  • Electrolytes: Na, K, Mg, Ca, Phos, Cl, acetate
  • Vitamins/Minerals/Trace Elements: zinc, selenium, copper, manganese, chromium and iodine
  • Optional: medications

Go to infosource/ at cwbc for the excel sheet on how to order TPN. Lots of useful data on pedmed.org in the appendix section about glucose infusion rate (GIR).

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