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Part IV
28 | Rizaelle Pillejera
2DPH
MAINTENANCE THERAPY
If patient is unable to take oral nutrition or fluids for longer periods (36 days);
REPLACEMENT THERAPY
WATER REQUIREMENT
<10kg: 100mL/kg/day
10 to 20kg: 1000mL + 50 mL/kg/day for weight over 10kg
20kg to maximum of 80kg: 1500mL + 20mL/kg/day for
weight over 20kg
In water replacement therapy for adults, 70mL/kg/day
may be required in addition to maintenance water
requirements; a badly dehydrated infant may require an
even greater portion.
Intravenously administered water may cause osmotic
hemolysis of red blood cells, this is why parenteral
administration of water is generally as a solution with
dextrose or electrolytes with sufficient tonicity to protect
the red blood cells from hemolyzing.
ELECTROLYTE REQUIREMENT
Potassium
Primary intracellular cation; important for normal cardiac and
skeletal muscle function
Usual daily dose intake is about 100 mEq
Usual daily loss is about 40 mEq
Can be lost through:
Excessive perspiration
Repeated enemas
Trauma (such as severe burns)
Uncontrolled diabetes
Disease of the intestinal tract
Surgical operation
Use of medications such as thiazide and loop diuretics
ELECTROLYTE REQUIREMENT
Weak pulse
Faint heart sounds
Falling blood pressure
General weakness
Caused by kidney failure or excessive consumption of potassiumrich foods, prescribed potassium supplements, potassium-sparing
diuretic therapy, angiotensin-converting enzyme inhibitors, and the
indiscriminate use of OTC salt substances.
ELECTROLYTE REQUIREMENT
20 to 40 mEq/L
ELECTROLYTE REQUIREMENT
Sodium
Principal extracellular cation; vital to maintain normal extracellular
fluids.
Average daily intake of sodium is 135 to 170 mEq (8-10 g)
The body is able to conserve sodium when this ion is lost or removed
from the diet.
When there is a sodium loss, 3 to 5g of NaCl should prevent a
negative sodium balance.
Low sodium level in the body may result from:
Excessive sweating
Use of certain diuretics
Diarrhea
Fatigue
Muscle weakness
Apprehension
Convulsion
ELECTROLYTE REQUIREMENT
ELECTROLYTE REQUIREMENT
Chloride
Principal anion of the extracellular fluid; usually paired
with sodium
Also important for muscle contraction
Balances the fluid levels inside and outside the cells
Maintains the acid-base balance of the extracellular fluid
Adequate amount of chloride is necessary to prevent
bicarbonate (second most prevalent anion) from tipping
the acid-base balance to the alkaline side.
CALORIC REQUIREMENTS
Body weight - in the fasting state, the average daily loss of body
protein is approximately 80g/day for a 70kg man. Daily ingestion of
at least 100g of glucose reduces this loss by half.
PARENTERAL NUTRITION
Electrolytes
Sodium 35mEq
Potassium 30mEq
Magnesium 5mEq
Calcium 5mEq
Chloride 40mEq
Acetate 35mEq
Phosphate 15mEq
Vitamins
L-Isoleucine 500mg
L-Leucine 770mg
L-Lysine acetate 85mg
L-Methionine 450 mg
L-Phenylalanine 480 mg
L-Threonine 340mg
L-Tryptophan 130mg
L-Valine 560 mg
L-Alanine 600mg
L-Arginine 810mg
L-Histidine 240mg
L-Proline 950mg
L-Serine 500mg
Aminoacetic acid 1.19g
PARENTERAL NUTRITION
PARENTERAL NUTRITION
PARENTERAL NUTRITION
Baxa Compounder
ENTERAL NUTRITION
ENTERAL NUTRITION
ENTERAL NUTRITION
Important considerations:
Type of tubing
Location of the enteral tube
Bulk-forming laxatives and cholestyramine resin should
not be used because of the possibility of clogging the
tubing
Enteral feedings can alter the absorption of certain
drugs; timing of administration is critical
Disadvantages
Intrinsic Factors
Operating mechanisms
Flow accuracy
Flow continuity
Occlusion detection
Extrinsic Factor
Back pressure
Pump Classifications:
Mechanism of Operation
Peristaltic
Piston
Diaphragm
Continuous or intermittent
Bolus dosing
Single solution
Multiple Solution
Therapeutic Application
PCA
MANUFACTURER
FEATURES
Colleague CX
Baxter
Basic delivery
programming, and ability
to piggyback secondary
medications.
Symbiq
Hospira
Plum A+
Hospira
Automated piggyback
delivery, automated
concurrent delivery etc.
B. Braun
DoseScan technology;
match the right drug to
the right patient.
Flo-gard
Baxter
SPECIAL CONSIDERATIONS
ASSOCIATED WITH PARENTERAL
THERAPY
STANDARDIZATION OF INTRAVENOUS
CONCENTRATIONS
LOOK-ALIKE PRODUCTS
To prevent mix-ups in
which one drug product
is selected in error
because of its similarity
in appearance to
another, storage shelves
should be labeled to
warn about this
A
recent example of a serious medication error
possibility.
occurred when Lupron Depot-Ped 11.25mg, a 1month gonadotropin-releasing analog used to treat
central precocious puberty, was confused with
Lupron Depot 3 Month.
ADSORPTION OF DRUGS
ADSORPTION OF DRUGS
Amiodarone HCl
Chlorpromazine HCl
Diazepam
Lorazepam
Nitroglycerin
Promazine HCl
Promethazine HCl
Thiopental sodium
Thioridazine HCl
Trifluoperazine HCl
Warfarin sodium
ADSORPTION OF DRUGS
LEVONORGESTREL IMPLANTS
IRRIGATION SOLUTIONS
IRRIGATION SOLUTIONS
DIALYSIS SOLUTIONS
DIALYSIS SOLUTIONS
DIALYSIS SOLUTIONS
Acetaminophen
Captopril
Cefaclor
Imipenem
Lithium
Metformin
DIALYSIS SOLUTIONS