Page 2311 - Cote clinical veterinary advisor dogs and cats 4th

Parenteral Nutrition 1149

○ Hypokalemia: if present, supplement IV ○ Infection: if occurs, remove catheter weight if overweight, such as body condi-
fluids with potassium chloride (p. 516). and culture the tip. Replace with a new ○ Formula: RER = 70 + 30 × (body weight in
tion score > 6/9).
VetBooks.ir ○ Hypophosphatemia: if present, supplement Procedure kilograms) for patients weighing 2-30 kg;
Monitor for hypomagnesemia.
catheter in a new location.
0.75
use 70 × (body weight in kilograms)
IV fluids with potassium phosphate, or add
potassium phosphate to PN formulation.
for patients that weigh outside this range.
○ Hypomagnesemia: if present, supplement PN prescription formulation: ○ Start with a caloric goal of the RER, and
• Choose between central or peripheral venous
IV fluids with magnesium sulfate, or add administration. adjust based on patient response.
magnesium sulfate to PN formulations. ○ Central is preferred for smaller volumes of • Decide which percentage of calories will be
○ Hyperlipidemia: if present, reduce or omit PN and lower risk of thrombophlebitis. delivered as protein, depending on the patient’s
the lipid emulsion. ○ Peripheral is possible if central is not level of protein tolerance or deficiency.
• Catheter complications available, but the patient must be ○ Dogs: provide 15%-25% of goal calories
○ Loss of venous access secondary to catheter fluid tolerant because required lower as protein (4-6 g/100 kcal).
malposition or thrombosis: if occurs, tonicity means a larger volume of ○ Cats: provide 25%-35% of goal calories
replace catheter. infusate. as protein (6-8 g/100 kcal).
○ Thrombophlebitis: if occurs, replace cath- • Calculating the caloric goal ○ Amino acid solutions: provide 4 kcal/g. Procedures and Techniques
eter. Select peripheral catheters that are long ○ Calculate the resting energy requirement ○ To calculate the volume of amino acid
and made of nonthrombogenic materials, (RER) using the patient’s current body solution required
especially with peripheral infusions. weight (or the animal’s estimated ideal ■ Divide the protein calories by 4 kcal/g
= grams of amino acids required
Divide the grams of amino acids
■
Sample Worksheet for a 17.5-kg (39-lb) Dog: Centrally Administered required by the grams of amino acids
Parenteral Nutrition Calculation per milliliter in the solution = volume
CANINE HIGH-PROTEIN REGIMEN of amino acid solution
○ NOTE: for peripheral infusion, use ≤ 6%
Weight: 17.5 kg Resting energy requirement (RER) = 600 kcal/day amino acid solutions because of high
Day 1 goal 50% RER = 0.5(600) = 300 kcal osmolarity.
• Decide which percentage of nonprotein
Day 2 goal 100% RER = 600 kcal
calories will be delivered as dextrose, with
% Protein calories 25% the remainder to be delivered as lipid.
Nonprotein calories 50% from lipid, 50% from dextrose ○ 100% of the nonprotein calories can be
Solutions delivered as dextrose, but hyperglycemia is
8.5% Amino acids (without electrolytes) a common sequela; 50% dextrose provides
1.7 kcal/mL.
50% Dextrose ○ Alternatively, lipid emulsions can be used
20% Lipid emulsion for delivering 50%-70% of the nonprotein
calories; 20% lipid emulsions provide
Potassium phosphate (3 mM/mL)
2 kcal/mL.
Injectable B complex ○ NOTE: for peripheral venous infusion, a
Day 1 Calculations high percentage of nonprotein calories
Amino Acids from lipid is preferred because the lipid
0.25 × 300 kcal = 75 kcal from protein emulsions are iso-osmolar. They are also
more calorically dense than dextrose solu-
There are 4 kcal/g protein; therefore, the patient needs 18.75 g of protein: 75 kcal ÷ 4 kcal/g = 18.75 g tions that can be safely infused peripherally
8.5% amino acid solution = 0.085 g protein/mL; therefore, the animal needs 220 mL 8.5% amino acid (≤20% dextrose).
solution: 18.75 g ÷ 0.085 g/mL = 220 mL • Add 0.2 mL/100 mL total infusate of vitamin
Nonprotein Calories B complex.
0.75 × 300 kcal = 225 kcal • Decide whether electrolytes will be added.
○ Supplementation may not be necessary if
50% dextrose to provide 50% nonprotein calories = 112.5 kcal. 50% dextrose solution = 1.7 kcal/mL; amino acid solutions containing additional
therefore, the patient needs 66 mL 50% dextrose solution: 112.5 kcal ÷ 1.7 kcal/mL = 66 mL electrolytes are used.
20% lipid emulsion to provide 50% nonprotein calories = 112.5 kcal. 20% lipid emulsion = 2 kcal/mL; ○ CAUTION: supplementation is contrain-
therefore, the patient needs 56 mL 20% lipid emulsion: 112.5 kcal ÷ 2 kcal/mL = 56 mL dicated in patients with kidney disease/
Potassium Phosphate renal failure.
○ Potassium phosphate: 8 mEq/1000 kcal
Dosed at 8 mM/1000 kcal delivered; therefore, the patient needs 2.4 mM potassium phosphate: (8 mM ×
300 kcal) ÷ 1000 kcal = 2.4 mM ○ Magnesium sulfate: 0.8 mEq/100 kcal
• Calculate the hourly infusion rate by dividing
Potassium phosphate solution = 3 mM/mL; therefore, the patient needs 0.8 mL potassium phosphate: the total volume by 24.
2.4 mM ÷ 3 mM/mL = 0.8 mL
Vitamin B Complex Postprocedure
Dosed at approximately 2 mL/L infused • Delivery
Total infusate for day 1 = 343 mL; therefore, 1 mL B complex should be sufficient. ○ Deliver the solution at a constant rate
using an infusion pump.
Infusion Rate ○ Administer 50% of the goal infusion, and
343 mL ÷ 24 h = 14 mL/h monitor for metabolic complications the
Day 2 Calculations first day, advancing to the goal rate the
Same calculations as those for day 1, but substitute 600 kcal for 300 kcal. next day if no problems occur that cannot
be addressed.

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