Page 466 - Small Animal Clinical Nutrition 5th Edition

480 Small Animal Clinical Nutrition

Table 26-2 continued
VetBooks.ir Chromium 8 mg

Final osmolarity
768
Approximate cost = $100 per day
PART C. CANINE FORMULA EXAMPLE
Animal data
Body weight 14 kg
RER 507 kcal/day
Calories from fat 90%
Calories from glucose 10%
Protein-calorie ratio 3 g/100 kcal
Fluid volume 70 ml/kg
Potassium concentration 20 mEq/l
Parenteral solution
50% dextrose 30 ml providing 51 kcal
20% lipid emulsion 227 ml providing 454 kcal
8.5% amino acids with electrolytes 176 ml providing 15 g of amino acids
Potassium phosphate 1.4 ml
Vitamin-B complex 5 ml
Trace elements 5 ml
NormaSol R 543 ml
Total fluid volume 987 ml
This final solution is a 1-liter bag containing 507 kcal (90% from fat), adequate nitrogen, major B vitamins
with the following electrolyte profile
Sodium 88.0 mEq/l
Potassium 20.3 mEq/l
Magnesium 3.5 mEq/l
Phosphorus 9.9 mM/l
Chloride 65.5 mEq/l
Calcium 0 mEq/l
Zinc 5 mg
Copper 2 mg
Chromium 20 mg
Manganese 0.5 mg
Final osmolarity 523 mOsm/l
Approximate cost = $100 per day

loid solution (e.g., lactated Ringer’s solution, Plasmalyte A) to 1995; DeBiasse and Wilmore, 1994). Energy is routinely pro-
meet the patient’s daily fluid requirement. Then electrolytes vided to veterinary patients receiving PN as a combination of
are adjusted, if necessary (Table 26-2). Alternatively, crystal- dextrose and lipid. Several companies manufacture dextrose
loid fluids with added potassium may be administered by a and lipid products of various strengths and attributes (Table
separate intravenous line piggybacked into the same catheter. 26-3). Most TNA solutions formulated for veterinary patients
use 50% dextrose and 20% lipid. Dextrose solutions range from
Energy Solutions 2.5 to 70% glucose, which is usually derived from hydrolyzed
A TNA solution should supply sufficient energy to meet, but cornstarch. Osmolarity ranges from 126 to 3,530 mOsm/l and
not exceed, the patient’s daily RER. Negative consequences of is directly proportional to the glucose concentration (AHFS
PN administration (i.e., metabolic complications) are often due Drug Information, 1997). Dextrose solutions are maintained in
to administering energy in excess of the patient’s expenditure the pH range of 3.5 to 5.5 and are sterilized by autoclave to
(Deitel et al, 1983; Chang and Silvis, 1974; VA Study Group, prolong shelf life at room temperature.
1991; Lippert et al, 1993). Early PN solutions for people con- Lipid (10, 20 or 30%) products (Table 26-3) contain emulsi-
tained dextrose and “liberal” amounts of protein. These solu- fied fat particles (0.5 mm) of soybean oil and/or safflower oil,
tions were administered at rates providing 3,000 to 5,000 glycerin and linoleic and linolenic acids. Earlier formulations
kcal/day (12.55 to 20.92 MJ) to a 70-kg person (Solomon and made with cottonseed oil were taken off the market in 1965
Kirby, 1990). This “hyperalimentation” actually increased because they caused severe adverse reactions in people. Lipid
catabolism by exceeding the patients’ endogenous usage of emulsions are maintained in a pH range of 6.0 to 8.9 and have
energy and produced multiple adverse metabolic effects. an osmolarity range of 260 to 310 mOsm/l, which effectively
Human patients are given 1,000 to 2,400 kcal (4.2 to 10 MJ) decreases the final osmolarity of the TNA (AHFS Drug
with 75 to 100 g of protein per day with fewer metabolic com- Information, 1997). Dextrose and lipids are readily available
plications (Woolfson, 1983). Currently, people are fed at RER and both are strongly recommended as sources of energy in a
instead of RER times a disease factor (McMahon, 1993; Forse, TNA solution.