Alys Latimer, Layla Mohamed, and Sandra Zheng
what IS tpn?
Total Parenteral Diet (TPN):
Infusion of intravenous nutrition (macro- and micro- nutrients)
Those with contraindications to oral diet approach
Specialised mixtures of amino acids, dextrose, lipid emulsions, electrolytes, minerals and vitamins
Infused centrally into internal jugular or subclavian blood vessels
INDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disorders
ADVERSE ISSUES: infections, post-op wound complications, immune endanger, fluid/electrolyte discrepancy, GI blood loss, etc .
(Arya et ‘s., 2013)
What is hypokalemia?
Hypokalemia:
Normal Results: 3. your five 5. 0 mEq/L
Important Values: <, 2 . 5 mEq/L
Potassium (K+), essential part of necessary protein synthesis and maintenance of normal oncotic pressure and cell electrical neutrality
(Pagana & Pagana, 2013)
Signs and Symptoms of Hypokalemia
Commonly not present until Potassium levels are much less than several. 0 mEq/L
Signs and symptoms of hypokalemia are normally related to heart failure, skeletal, and smooth muscle weakness
CARDIOVASCULAR: flattened T-wave and visible U-wave, STREET segment despression symptoms, conduction abnormalities, dysrhythmias, worsening hypertension, abrupt death
KIDNEY: polyuria, hypokalemic nephropathy, improved risk of nephrolithiasis, and chloride-depletion metabolic alkalosis
CNS/NEUROMUSCULOSKELETAL: tiredness, malaise, hyporeflexia, weakness, cramping, paralysis, myalgia, and rhabdomyolysis
GI TRACT: Constipation, throwing up, prolonged gastric emptying, paralytic ileus, beoing underweight, worsening hepatic encephalopathy
GU TRACT: hypotonic bladder
PULMONARY: respiratory acidosis, respiratory failing
ENDOCRINE: insulin amount of resistance and disability in insulin release
(Asmar et ‘s., 2012, Elgart, 2004, Pagana & Pagana, 2013)
Tips on how to treat hypokalemia?
Treatment Options:
GOAL: identifying defined cause of hypokalemia, prevent the progress life-threatening consequences, and correct any potassium shortage which steering clear of hyperkalemia
SLIGHT MODERATE HYPOKALEMIA (3. 0 3. 5 MEQ/L):
Handle underlying disorder if possible
Deal with with sixty 80 mEq/d of KCl via PO in divided doses
Reassess serum potassium focus after alternative therapy and adjust consequently
SEVERE HYPOKALEMIA (<, several. 0 MEQ/L):
Preferred: 40 mEq/d of KCl through PO q3-4h TID
Reflect on serum potassium concentration after replacement therapy and adjust accordingly
If necessary: 10 20 mEq/h of KCl through IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicity
Continuous heart monitoring is mandatory
Reassess serum potassium focus q2-4h (ensure that serum potassium attentiveness is >, 3. a few mEq/L)
(Asmar et approach., 2012)
Thank you
Sources:
Asmar, A., Mohandas, 3rd there’s r., & Wingo, C. S i9000. (2012). A physiologic-based method to the treatment of a
patient with hypokalemia. American Journal of Kidney Conditions: The Official Log of the Nationwide
Kidney Base, 60(3), 492 497. doi: 10. 1053/j. ajkd. 2012. 01. 031
Arya, We. N., Shah, B., Arya, S., Dronavalli, S., & Karthikenyan, N. (2013). A review of literature on modernparenteral diet. International Diary of Medical Science and Public Health, 2(4), 801 806. doi: 15. 5455/jimsph. 2013. 030920131
Elgart, H. In. (2004). Examination of essential fluids and electrolytes. AACN Specialized medical Issues, 15(4). 607-621. Retrieved from: https://learn.humber.ca/bbcswebdav/pid-4534008-dt-content-rid24071933_1/courses/1528.201750/Assessment%20of%20Fluids%20and.pdf
Pagana, E. D., & Pagana, T. J. (2013). Mosbys Canadian manual of diagnostic and laboratory tests (First
Canadian ed. ). Toronto, ABOUT: Elsevier Canada
