TABLE 20-16 -- INITIATION AND ADVANCEMENT OF PARENTERAL NUTRITION *

Nutrient

Initial Dose

Advancement

Maximum

Glucose

5% to 10%

2.5% to 5%/day

12.5% peripheral
18 mg/kg/min (maximum rate of infusion)

Protein

1 g/kg/day

0.51 g/kg/day

3 g/kg/day
10%16% of calories

Fat

0.51 g/kg/day

1 g/kg/day

4 g/kg/day
0.17 g/kg/hr (maximum rate of infusion)

Modified from Baker RD, Baker SS, Davis AM. Pediatric parenteral nutrition. New York: Chapman and Hall; 1997 and Cox JH, Cooning SW. Parenteral nutrition. In Samour PQ, Helm KK, Lang CE, editors. Handbook of pediatric nutrition. Gaithersburg, Md; Aspen; 1999.

*Acceptable osmolarity of parenteral nutrition through a peripheral line varies between 900-1050 osm/L by institution. An estimate of the osmolarity of parenteral nutrition can be obtained with the following formula: Estimated osmolarity = (dextrose concentration 50) + (amino acid concentration 100) + (mEq of electrolytes 2). Consult individual pharmacy for hospital limitations.





TABLE 20-17 -- DAILY PARENTERAL NUTRIENT RECOMMENDATIONS

Component

01 yr

17 yr

>7 yr

Energy (kcal/kg)

80120

5590

5575

Protein (g/kg)

23

1.52.5

1.52.5

Sodium (mEq/kg)

34

24

24

Potassium (mEq/kg)

23

23

23

Magnesium (mEq/kg)

0.251

0.251

0.251

Calcium (mg/kg)

4060

1050

1050

Phosphorus (mg/kg)

2045

1540

1540

Zinc (mcg/kg)

400 (preterm)
100

100

100 (maximum 4 mg/day)

Copper (mcg/kg)

20

20

20 (maximum 1.5 mg/day)

Chromium (mcg/kg)

0.2

0.2

0.2 (maximum 15 mg/day)

Manganese (mcg/kg)

210

210

210 (maximum 0.8 mg/day)

Selenium (mcg/kg)

3

3

3 (maximum 40 mg/day)

Modified from Baker RD, Baker SS, Davis AM. Pediatric parenteral nutrition. New York: Chapman and Hall; 1997 and Cox JH, Cooning SW. Parenteral nutrition. In Samour PQ, Helm KK, Lang CE, editors. Handbook of pediatric nutrition. Gaithersburg, Md; Aspen; 1999.

 

 

TABLE 20-18 -- MONITORING SCHEDULE FOR PATIENTS RECEIVING PARENTERAL NUTRITION *

Variable

Initial Period

Later Period

GROWTH

Weight

Daily

2 times/wk

Height

Weekly (infants)
Monthly

Monthly

Head circumference (infants)

Weekly

Monthly

Arm circumference

Monthly

Monthly

Skinfold thickness

Monthly

Monthly

LABORATORY STUDIES

Electrolytes and glucose

Daily until stable

Weekly

BUN/creatinine

2 times/wk

Weekly

Albumin or prealbumin

Weekly

Weekly

Ca2+ , Mg2+ , P

2 times/wk

Weekly

ALT, AST, Alk P

Weekly

Weekly

Total and direct bilirubin

Weekly

Weekly

CBC

Weekly

Weekly

Triglycerides

With each increase

Weekly

Vitamins

As indicated

Trace minerals

As indicated

Alk P, Alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; BUN, blood urea nitrogen; CBC, complete blood count.

*For patients on long-term parenteral nutrition, monitoring every 2 to 4 weeks is adequate in most cases.
The period before nutritional goals are reached or during any period of instability.
When stability is reached, no changes in nutrient composition.
Weekly in preterm infants.