靜脈營養(yǎng)的臨床應(yīng)用(文件)
【正文】 Clinical Congress, ASPEN 1998 Electrolytes Requirements for Adult Patients ? 1. Sodium 30 – 55 mEq/liter ? 2. Potassium 60 – 90 mEq/day ? 3. Chloride 30 – 55 mEq/liter ? 4. Calcium 6 – 12 mEq/day ? 5. Magnesium 16 – 20 mEq/day ? 6. Acetate 45 – 70 mEq/day ? 7. Phosphorus 18 – 28 mM/day Ref： a. Maxwell ＆ Kleeman,s Clinical Disorders of Fluid and Electrolyte Metabolism ,5th , 1994 . b. Allin I. Arieff , . Fluid, Electrolyte, and AcidBase Disorders . 2nd Ed 1995 . Vitamins Adult RDA in USA AMA Remended Remendation For the Critically Ill Vitamin A（ IU） Vitamin D（ IU） 4000 5000 400 3300 200 2500 – 10000 400 Vitamin E（ IU） Vitamin C（ mg） 12 15 45 400 1000 Folic acid（ mcg） Niacin（ mg） 400 12 20 2022 200 Vitamin B2（ mg） Vitamin B1（ mg） – – 10 10 Vitamin B6（ mg） Vitamin B12（ mcg） – 3 20 20 mg Pantothenic acid（ mg） Biotin（ mcg） 5 – 10 150 300 100 5 mg Vitamin K（ mg） 1. 1 – 10 mg/wk 2. Antibiotics – 10 mg/34days Vitamin Formulation For Children Aged 11 Years, Older and Adults Essential Trace Elements AMA/NAG Suggested Daily IV Intake Element Stable Acute Catabolic GI Losses Zn – mg Additional 2 mg Add mg/L small Bowel fluid lost； mg/kg of stool or ileostomy output Cu – mg Cr 10 – 15 mcg 20 mcg Mn – mg Metabolic Complications of PN ?Steatosis ?Cholestasis, Gallbladder Stasis, and Cholelithiasis ?Gastrointestinal Atrophy ?Gastric Hypersecretion and Hyperacidity Macronutrient related Complications ?Overfeeding ?Refeeding syndrome Metabolic Complications of PN Steatosis ? Within 12 weeks after initiation of PN ? Elevations of Serum aminotransferases, alkaline phosphatase and bilirubin ? Fatty infiltration of liver cells ? Continuous glucose and/or excessive calorie loads ? Resolves in 1015 days Metabolic Complications of PN Cholestasis, Gallbladder Stasis, and Cholelithiasis ? May occur 26 wks after initiation PN ? Progressive increase total bilirubin and serum alkaline phosphatase ? minimize the risk ? Cyclic PN ? Restrictin of carbohydrate, ? Avoidance of overfeeding ? Early enteral stimulation Metabolic Complications of PN Gastrointestinal Atrophy ? Lack of enteral stimulation cause ? villus hypoplasia ? Colonic mucosal atropy ? Decrease gastric function ? Impaired GI immunity ? Bacterial overgrowth ? Bacterial translocation ? Initiate enteral feedings as soon as possible Metabolic Complications of PN Gastric Hypersecretion and Hyperacidity ? Gastric secretions directly related to the amount of small bowel resected ? Peptic ulcerations and hemorrhagic gastritis ? Histamine H2 receptor antagonists are used to decrease gastric output ? Added directly to the PN solution 適當(dāng)靜脈營養(yǎng)支持注意要點(diǎn) ? 預(yù)防高血糖癥
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