Page 630 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Parenteral Nutrition 617

BOX 25-5 Worksheet for Calculating a Partial Parenteral Nutrition
Formulation

1. Resting energy requirement (RER) ____kcal from protein 0.34 kcal/mL ¼ ____mL
70 (current body weight in kilograms) 0.75 ¼ kcal/day or amino acids/day
for animals weighing 3 to 25 kg can also use: c. 20% lipid solution ¼ 2 kcal/mL
30 (current body weight in kilograms) þ 70 ¼ kcal/day ____kcal from lipid 2 kcal/mL ¼ ____mL lipid/day
RER ¼ ____kcal/day 5. Total daily requirements
2. Partial energy requirement (PER) ____mL 5% dextrose solution
Plan to supply 70% of the animal’s RER with PPN: ____mL 8.5% amino acid solution
PER ¼ RER 0.70 ¼ ____kcal/day ____mL 20% lipid solution
3. Nutrient composition ____mL total volume of PPN solution
(Note: For animals 3 kg, the formulation will provide a 6. Administration rate
fluid rate higher than maintenance fluid requirements. This formulation provides approximately a maintenance
Be sure that the animal can tolerate this volume of fluid rate.
fluids.) ____mL/hr PPN solution
a. Cats and dogs weighing 3-5 kg: Be sure to adjust the patient’s other intravenous fluids
PER 0.20 ¼____kcal/day from dextrose accordingly.
PER 0.20 ¼____kcal/day from protein Notes:
PER 0.60 ¼____kcal/day from lipid
b. Cats and dogs weighing 6-10 kg: * Fluids can be added directly to the PPN solution (at the
PER 0.25 ¼____kcal/day from dextrose time of compounding only).
PER 0.25 ¼____kcal/day from protein * In some cases, the calculated PPN rate may be greater than
PER 0.50 ¼____kcal/day from lipid maintenance fluid requirements or greater than what the
c. Dogs weighing 11-30 kg: animal can tolerate (e.g., cardiac disease).
PER 0.33 ¼____kcal/day from dextrose * The monitoring required will depend on the individual
PER 0.33 ¼____kcal/day from protein patient. However, at least the following should be
PER 0.33 ¼____kcal/day from lipid measured daily:
d. Dogs weighing >30 kg: * Heart/respiratory rate
PER 0.50 ¼____kcal/day from dextrose * Catheter site
* Attitude
PER 0.25 ¼____kcal/day from protein
* Body weight
PER 0.25 ¼____kcal/day from lipid
* Temperature
4. Volumes of nutrient solutions required each day
* Glucose, total solids (check hematocrit tubes for
a. 5% dextrose solution ¼ 0.17 kcal/mL
lipemia)
____kcal from dextrose 0.17 kcal/mL ¼____mL
* Electrolytes should be monitored at least every
dextrose/day
other day
b. 8.5% amino acid solution ¼ 0.085 g/mL ¼ 0.34
kcal/mL
BOX 25-6 Calculation of wrapped, but the bandage should be changed daily so
Osmolarity of that the catheter site can be evaluated. This practice will
Parenteral Nutrition help to identify swelling, erythema, or malpositioning of
Admixture the catheter. All handling of the catheter and lines should
bedoneusingaseptictechnique.Appropriatecathetercare
has been shown to be one of the most effective measures in
[(mL ofamino acids osmolarity ofamino acid solution) þ 2,56
reducing catheter-related complications.
(mLofdextrose osmolarityofdextrosesolution)þ(mLof
lipid osmolarity of lipid solution) þ (mL of additional There also has been some concern associated with par-
fluids osmolarity of fluids)] total volume of parenteral enteral nutrition admixtures leaching plasticizers (e.g.,
nutrition diethylhexylphthalate (DEHP) from polyvinylchloride
infusion lines and bags causing hepatic injury. 44,45
The risk if particularly high in infants when long-term
infusions ( >1 month) are used. It is unknown if this is
in place for longer periods compared with normal a problem in animals receiving parenteral nutrition
catheters and provide additional ports for blood sampling for less than 5 days, which is the typical course of
and administration of additional intravenous fluids and parenteral nutrition in animals. Recommendations for
medications. All catheters should be well secured and reducing the risk of DEHP toxicity involves using lines