Karnataka PGET Surgery MCQ Answer 14

The correct answer is C

Total parental nutrition (TPN or central parental nutrition) provides the entire nutrient needs of the patient via intravenous infusion. Central venous access is preferred for parenteral nutrition administration since the rate of blood flow rapidly dilutes the hypertonic parenteral feeding formulation. The glucose content of TPN is high (usually 15% to 70% concentration depending on the total volume) and TPN includes amino acids (3% to 10%), electrolytes, minerals, trace elements, and vitamins. TPN is a hyperosmolar (1300-1800mOsm/L) formulation that requires a large-diameter vein, usually the superior vena cava.

According to A.S.P.E.N. (American Society for Parenteral and Enteral Nutrition) parenteral nutrition is indicated for patients that need bowel rest associated with:

Indications for total parenteral nutrition

• Absolute indications
  • Enterocutaneous fistulae
• Relative indications

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  • Moderate or severe malnutrition
  • Acute pancreatitis
  • Abdominal sepsis
  • Prolonged ileus
  • Major trauma and burns
  • Severe inflammatory bowel disease
  • Intestinal failure = ‘A reduction in functioning gut mass below the minimal necessary for adequate digestion and absorption of nutrients’

Parenteral nutrition is also often used when enteral feedings are unsuccessful as seen by high residuals or pulmonary aspiration. In critically ill patient, parenteral nutrition is indicated if enteral nutrition is not possible and hypermetabolism is expected to last more than 4-5 days.

Category: Karnataka PGET 2007 MCQs