General principles of parenteral nutrition
With advances in the various aspects of clinical medicine the need and indications for parenteral nutrition are increasing progressively. This is due to a combination of availability of better medical and surgical facilities to treat conditions which were hitherto lethal; increasing age of patients so treated; and increasing awareness on the part of doctors, nurses and nutritionists, of the importance of providing adequate nutrition and of the fact that in potentially curable situations patients may actually die because of malnutrition. This is particularly true in conditions of high metabolic stress such as acute renal failure, burns and other major trauma (surgical or otherwise). In this age of ‘hi-tech’ medicine and bioengineering it is only too easy to concentrate on intensive therapeutic modalities such as dialysis, cardiopulmonary monitoring and assisted ventilation and neglect the most fundamental aspect of patient management, namely provision of adequate food! It is worth bearing in mind that patients who are even moderately unwell are rarely capable of eating adequate amounts on their own. Thus it is essential for everyone involved in patient care to constantly address themselves to the question of whether or not each patient is receiving sufficient nutrition. The average human being has rather limited energy reserves and virtually no protein reserve. Thus in a situation of demand with inadequate supply the body rapidly uses up the energy reserves and then proceeds to break down protein for further energy, resulting in progressive loss of body cell mass.
KeywordsParenteral Nutrition Total Parenteral Nutrition Nutritional Support Nitrogen Loss Rest Energy Expenditure
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