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).