NUTRITION

Caloric requirement in adults – 40kcal/kg/day

Carbohydrates 50% , fat  30-40% and protein 10-15%

Caloric value- carbohydrate and protein - 4kcal/g and fat – 9kcal/g

Indications of nutritional supplementation

• Preoperative nutritional depletion
• Burns
• Trauma
• Anorexia nervosa and intractable vomiting
• Pancreatitis, malabsorption, ulcerative colitis, pyloric stenosis
• High output intestinal fistulas
• Postoperative complications like sepsis, ileus and fistula
• Malignant disease

Methods of feeding

Enteral feeding

• GI tract is the best route to provide nutrition.
• Can be done 

i.Orally

ii.By nasogastric tube

iii.By enterostomy e.g. gastrostomy and jejunostomy in severe malnutrition, major surgeries, severe sepsis

Total parenteral nutrition (TPN)

Indications:

• Failure or contraindication for any enteral nutrition
• High output intestinal fistulas
• Major abdominal surgery of liver, pancreas, biliary tract, colon
• Septicemia
• Multiple trauma
• Short bowel syndrome
• TPN is given through central vein and not through peripheral vein
• Components used in TPN – carbohydrates, fat, aminoacids, vitamins and trace elements
• Contraindications :
• Cardiac failure
• Blood dyscrasias
• Altered fat metabolism

Complications of TPN 

1.Due to placement of CVP

• Air embolism
• Pneumothorax
• Bleeding
• Infection 
• Catheter displacement, sepsis, blockage, thrombosis

2. Biochemical

• Electrolyte imbalance
• Hyperglycemia
• Hyperosmolarity
• Dehydration
• Azotemia 
• Altered immunological function

3. Others

• Dermatitis
• Anemia 
• Cholestatic jaundice.