Nutrition

Nutrition


Parenteral



Basic Information image



Synonym(s)




PN


Partial parenteral nutrition (PPN)


Total parenteral nutrition (TPN)



Overview and Goal(s)




• Parenteral nutrition (PN) is nutritional support administered intravenously.


• The goal of PN is to supply a portion (PPN) or the horse’s complete nutritional needs (TPN) to maintain hypermetabolic patients (ie, sepsis, burns) or caloric deficient patients (ie, gastrointestinal disease).


• The objective of PN is to reduce catabolism and the deleterious effects of malnutrition on immunity, wound healing, and survival rates



Indications




• Intravenous nutrition is indicated in diseases or disorders that prevent adequate intake or absorption of enteral feeds.


image Gastrointestinal ileus (anterior enteritis, postoperative ileus)

image Infectious or inflammatory bowel disease (necrotizing enterocolitis, salmonellosis)

image Dysphagia (encephalopathy, botulism)

image Hyperlipemia/insulin resistance (miniature horses, ponies, donkeys)

image Concurrent pregnancy/lactation with systemic illness

image Severe trauma/burns


Contraindications




• If an animal is able to take in feed enterally, or will be fed within the next 5 days in adults (or next 2 days in foals), enteral feeding is preferred to PN to maintain enterocyte health.


• Thromboembolic disease or coagulation disorders may increase the risk of venous thrombosis.



Equipment, Anesthesia




• Catheter


image Catheter material should be silicone or polyurethane to reduce risk of thrombosis.

image A large vessel is required (typically the jugular vein) due to the hypertonicity of these solutions.

image Multilumen catheters are preferred to allow the solution to enter through a dedicated catheter and line to reduce contamination and drug interactions without increasing the number of veins catheterized.

image If a single jugular catheter is used, flush with 100 mL of fluid before and after medications.

image All catheters should be placed under sterile conditions.

• Parenteral nutrient mixture


image Amino acid mixture (3%–10% concentration) to supply a protein base

image Hypertonic and basic (will irritate endothelium)

image Carbohydrate source (dextrose 10%–50% solution) for a nonprotein energy source

image Hyperosmolar: Dilute to <10% solution or infuse concurrently with crystalloids

image May separate lipid emulsions due to an acidic pH

image Lipid emulsion (10%–20%) provides additional (optional) calories, especially for insulin resistance.

image Optional

image Should be avoided in hyperlipemic states (triglycerides >300 g/dL)

image Electrolytes may be supplied with the amino acids or provided separately in the fluids administered.

image Fat-soluble vitamin and mineral parenteral admixtures may be added but typically are not needed if therapy will be administered for less than 2 weeks in duration.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Nutrition

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