NUTRITION

Caloric requirement in adults – 40kcal/kg/day
Carbohydrates 50% , fat  30-40% and protein 10-15%
Caloric value- carbohydrate and protein - 4kcal/g and fat – 9kcal/g

Indications of nutritional supplementation
  • Preoperative nutritional depletion
  • Burns
  • Trauma
  • Anorexia nervosa and intractable vomiting
  • Pancreatitis, malabsorption, ulcerative colitis, pyloric stenosis
  • High output intestinal fistulas
  • Postoperative complications like sepsis, ileus and fistula
  • Malignant disease

Methods of feeding

Enteral feeding
  • GI tract is the best route to provide nutrition.
  • Can be done 
i.Orally
ii.By nasogastric tube
iii.By enterostomy e.g. gastrostomy and jejunostomy in severe malnutrition, major surgeries, severe sepsis



Total parenteral nutrition (TPN)

Indications:
  • Failure or contraindication for any enteral nutrition
  • High output intestinal fistulas
  • Major abdominal surgery of liver, pancreas, biliary tract, colon
  • Septicemia
  • Multiple trauma
  • Short bowel syndrome
  • TPN is given through central vein and not through peripheral vein
  • Components used in TPN – carbohydrates, fat, aminoacids, vitamins and trace elements
  • Contraindications :
  • Cardiac failure
  • Blood dyscrasias
  • Altered fat metabolism
Complications of TPN 

1.Due to placement of CVP
  • Air embolism
  • Pneumothorax
  • Bleeding
  • Infection 
  • Catheter displacement, sepsis, blockage, thrombosis
2. Biochemical
  • Electrolyte imbalance
  • Hyperglycemia
  • Hyperosmolarity
  • Dehydration
  • Azotemia 
  • Altered immunological function
3. Others
  • Dermatitis
  • Anemia 
  • Cholestatic jaundice.

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