Basic Concepts in Parenteral Nutrition

Energy stores of an adult

Store

Quantity

Use

Exhaustion

Net body
protein

10% BW

Glucose precursor

wide, situationdependent

Liver
glycogen

300 g

Glucose precursor

24 h

Fat

20% BW

Fatty acid
40 days
& glucose precursor

Net body protein

glucose
100 g
56 g
Death from protein depletion occurs after loosing 1/3
to 1/2 of net body protein

Caloric value of nutrients

Calories produced by the combustion of 1 gram of
various substrates:
Substrate
Energy (kcal/g)
Amino acids 4
Glucose
4
Fat 9

(10% emulsion: 1.1 kcal/ml)

(20% emulsion: 2 kcal/ml)
Glycerol
4
Alcohol
7

Objective of nutrition therapy

Avoid malnutrition
Maintain body tissue and functioning plasma
protein stores
Prevent macro- and micro-nutrient deficiencies
Normal
muscle mass
visceral protein
organ function
immune
response
wound healing

complications
infections
Multiple organ
failure
(lung, GI, liver,

Basal metabolic rate

Harris-Benedict Equation
BMR (men)= 66 + (13.7 x BW) + (5 x H) - (6.8 x A)
BMR (women) = 655 + (9.6 x BW) + (1.7 x H) - (4.7
x A)

BW = body weight
in kg
H
= height in cm
A = age in years

Actual energy expenditure

AEE = BMR x AF x TF x IF
AF (Activity
Factor)
In bed
1.1
In bed, but mobile
1.2
Mobile
1.3
TF (Thermal
Factor)
38oC
1.1
39oC
1.2
40oC
1.3
41oC
1.4

IF (Injury Factor)
Uncomplicated patient
1.0
Postoperative state 1.1
Fractures

1.2
Sepsis
1.3
Peritonitis
1.4
Multiple trauma
1.5
Multiple trauma
1.6
& sepsis
Burns 30 - 50%
1.7

Amino acids in parenteral nutrition

Amino acids (AA)

Essential AA
isoleucineBranche
leucine d chain
AA
valine
(BCAA)
methionine
- Aromatic
phenylalanine
AA
threonine
tryptophan
lysine

Non-essential AA
histidine *

glycine

arginine*

serine*

alanine

proline

asparagine

tyrosine*- Aromatic
(ornithine)
AA

aspartic acid
cysteine*

glutamic acid
glutamine

(* ?)

*Conditionally essential: essential in certain situation e.g.

restricted ability to synthesize or increased requirements that
cannot be met by de novo synthesis

http://www.cryst.bbk.ac.uk/education/AminoAcid/overvi
ew.html

B.Brauns Way
Amino Acid Solutions

Lipids in parenteral nutrition

Triglycerides
- esters of glycerol and 3 fatty acids, also called
triacylglycerols
- classified depending on chain lengths of free fatty
acids attached to glycerol
backbone e.g. SCT,
SCFA
SCFA
Short chain triglyceride
MCT, LCT
(SCT)
SCFA
MCFA
MCFA
Medium chain triglyceride
(MCT)
MCFA
Long chain triglycerideLCFA
(LCT)

LCFA
LCFA

Storage temperature of lipid

emulsions

Note well

Lipids,

B.Braun,s Way