General Surgery – Nutrition & Periop Management

Ans d

Visceral protein measurement (e.g., albumin, transferrin, prealbumin) are used for nutritional assessment

Serum albumin of less than 3.5 g/dL (35 g/L) in a stable, hydrated patient; half-life is 14 to 20 days.

2. Serum prealbumin may be a more useful indicator of acute changes: 10 to 17 mg/dL corresponds to mild depletion, 5 to 10 mg/dL to moderate depletion, and less than 5 mg/dL to severe depletion; half-life is 2 to 3 days.

3. Serum transferrin of less than 200 mg/dL; half-life is 8 to 10 days.

Indirect calorimetry: Fick equation, Harri s-Benedict equations and Estimated REE These 4 things measure the calorie and nutrition requirement. They are not indicators of previous nutritional status

Answer  2 (FREE)  b

Lipid Emulsions can be given by peripheral route. They are the highest source of energy and calories.  25% dextrose, although a good source of energy has high concentration of glucose which can cause thrombophelebitis.

DNS (Dextrose Normal Saline)

• Description: DNS is a combination of dextrose and normal saline (sodium chloride). It primarily provides carbohydrates (calories) and some sodium and chloride.
• Limitation: While it can provide calories, it is not the most efficient choice for increasing caloric intake through parenteral nutrition. The concentration of dextrose is relatively low compared to lipid emulsions.

B) Lipid Emulsions

• Description: Lipid emulsions are intravenous solutions that provide essential fatty acids and significant calories (up to 10 kcal/mL).
• Benefits: They are crucial for parenteral nutrition, especially when peripheral access is used, as they help prevent hyperglycemia from excessive dextrose and provide necessary calories efficiently.
• Conclusion: Lipid emulsions are the preferred choice for increasing calories in peripheral parenteral nutrition.

C) Arginine in DNS

• Description: This option refers to adding arginine (an amino acid) to a DNS solution. While arginine can have benefits, such as supporting immune function and wound healing, it does not significantly increase calorie intake.
• Limitation: The primary purpose of arginine is not to provide calories but to offer specific amino acid supplementation.

D) 25% Dextrose

• Description: A 25% dextrose solution is a concentrated source of carbohydrates. It provides approximately 1000 calories per liter.
• Limitation: While it can provide significant calories, using such a high concentration of dextrose peripherally can lead to complications like phlebitis and osmotic damage to veins. It's generally used in central venous access rather than peripheral routes.