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Chapter 38. Parenteral Nutrition

A 45-year-old man is admitted to the intensive care unit following a rock-climbing accident in which he suffers major trauma. He was well nourished and in good physical condition prior to the accident, and although his injuries are significant, he is not at high-nutritional risk. Enteral feedings (tube feedings) are started on day 2 of admission, but on day 4 they are discontinued due to intolerance. What is the best approach at this time?

a. Start parenteral nutrition (PN) with dextrose, amino acids, and soybean oil fat emulsion as soon as possible.

b. Start PN with dextrose and amino acids as soon as possible; hold soybean oil fat emulsion for now.

c. Keep trying to reinitiate enteral feedings and wait on starting PN until about day 8 of admission if the tube feedings are still not successful.

d. Because the patient was previously well nourished, hold both PN and enteral feedings until about day 14 of the hospitalization.

Answer c is correct. American Society for Parenteral and Enteral Nutrition (ASPEN) intensive care guidelines promote holding PN for the first 7 days of an intensive care admission in patients who were well nourished prior to admission and are not at high-nutritional risk. These guidelines also promote early initiation of enteral feedings if these can be safely administered.

Answer a is incorrect. ASPEN intensive care guidelines promote holding PN for the first 7 days of an intensive care admission in patients who were well nourished prior to admission and are not at high nutritional risk. These guidelines recommend holding soybean oil for the first 7 days of an intensive care admission regardless of the patient's nutritional status and nutritional risk.

Answer b is incorrect. ASPEN intensive care guidelines promote holding PN for the first 7 days of an intensive care admission in patients who were well nourished prior to admission and are not at high-nutritional risk.

Answer d is incorrect. Fourteen days without nutrition would be longer than recommended for intensive care patients.

Which one of the following products would prevent essential fatty acid deficiency with the smallest volume infused on a daily basis?

a. Smoflipid

b. Clinolipid

c. Intralipid

d. Clinimix

Answer c is correct. Intralipid is a soybean oil-based lipid emulsion which contains higher amounts of the essential fatty acids linoleic and linolenic acids compared to the newer lipid products, Smoflipid and Clinolipid.

Answer a is incorrect. Although ...

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