WASHINGTON UNIVERSITY IN ST. LOUIS SCHOOL OF MEDICINE PEDIATRICS GI PARENTERAL NUTRITION TPN Constituents
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Gastroenterology & Nutrition | Parenteral Nutrition

TPN Constituents



Glucose

Glucose provides the major energy source of parenteral nutrition. Although any concentration of glucose may be selected, certain concentrations provide for easier calculations and sufficient calories when employed with common infusion rates. Glucose provides 4 kcal/gm. Strictly speaking, glucose in PN solutions is hydrated and thus provides only 3.4 kcal/gm of actual hydrated weight. To simplify calculations, however, glucose is commonly estimated to provide its actual 4 kcal/gm. Thus, a 10% glucose or dexstrose solution supplies 40 kcal/100ml or 0.4 kcal/ml. A 20% glucose solution provides 0.8 kcal/ml.

For PN solutions infused via peripheral vein, glucose concentration should not exceed 12.5%. Higher concentrations of glucose produce PN solutions of sufficiently high osmolarity that venous endothelium may be damaged, resulting in venous thrombosis and sclerosis.

For PN solutions infused via central vein, the high venous flow rate rapidly dissipates the high osmolarity. Although a 20% glucose concentration is standard, concentrations as high as 40% can be employed if required by fluid restrictions.


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Amino Acids

Cyrstalline amino acids provide the building blocks for protein in PN. Standard commercially produced mixtures of essential and non-essential amino acids are available for compounding PN. Trophamine and Travasol are the two formulations most commonly employed at SLCH. Trophamine was designed for term and premature infants up to age 3 months. Trophamine infusion replicates the serum amino acid concentrations of a breast-fed infant. Travasol was designed for adults, but experience indicates that it meets the nutritional needs of children. Specialized formulations have been designed for patients with renal and hepatic disease, but evidence is lacking to demonstrate that these mixtures are more efficacious in those disorders.

  Trophamine 1.6% Travasol 1.6%

Essential Amino Acids
Isoleucine 13176
Leucine 224100
Valine 12573
Threonine 6767
Methionine 5393
Tryptophan 3229
Phenylalanine 77100
Lysine 13193

Semi-Essential Amino Acids
Histidine 7770
Tyrosine 376
Cysteine 65 added0
Taurine 40

Non-Essential Amino Acids
Glycine 59331
Alanine 85331
Proline 10967
Serine 610
Arginine 195166
Aspartate 510
Glutamine 800


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Vitamins in PN

Preparation:   MVI-Pediatric
(5 ml)
MVI-Adult
(10 ml)

Ascorbic acid 80 mg200 mg
Vitamin A 0.7 mg1.0 mg
Vitamin D 10 mcg5 mcg
Thiamine 1.2 mg6.0 mg
Riboflavin 2.0 mg3.6 mg
Pyridoxine 1.0 mg6.0 mg
Niacinamide 17 mg40 mg
Dexapanthenol 5.0 mg15 mg
Vitamin E 7.0 mg10 mg
Biotin 20 mcg60 mcg
Folic acid 140 mcg600 mcg
Vitamin B12 1 mcg5 mcg
Vitamin K 200 mcg150 mcg

Weight-based Vitamin Additives

The exact amount of MVI-Ped added to a PN solution depends on the patient's weight.

  Daily MVI-Ped Dose
Weight ≤ 1.5 kg 1.5 ml
Weight between
1.5 kg and 3 kg
3.25 ml
Weight > 3 kg 5 ml

Weight-based Trace Metal Additives

  TMA mixture
and volume
Constituents
Weight ≤ 3 kg Premature Trace
Element Mixture
(0.2 ml/kg/day)
  • Zinc 300 mcg/kg/day
  • Manganese 5 mcg/kg/day
  • Copper 20 mcg/kg/day
  • Chromium 0.17 mcg/kg/day
Weight between
3 kg and 20 kg
Pediatric Trace
Element Mixture
(0.2 ml/kg/day)
  • Zinc 200 mcg/kg/day
  • Manganese 5 mcg/kg/day
  • Copper 20 mcg/kg/day
  • Chromium 0.2 mcg/kg/day
Weight > 20 kg Trace Metal
Additive
(1 ml/day)
  • Zinc 5 mg/day
  • Manganese 0.5 mg/day
  • Copper 1 mg/day
  • Chromium 10 mcg/day

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Intravenous Lipid

Intravenous lipid provides essential fatty acids and supplemental calories. Intralipid is the standard commercial form of intravenous lipid.

Intralipid Constituents

Concentration 20%  
Water 76.5%  
*Soy Oil 20%

* Soy Oil contains
44 to 62% linoleic acid,
4 to 11% linolenic acid,
19 to 30% oleic acid,
7 to 14% palmitic acid,
and 1.4 to 5.5% stearic acid.

Phospholipid 1.2%  
Glycerol 2.25%  
kcal/ml 2.0  
mOsm/L 260  

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Osmolarity of Usual PN Solutions

Solution Osmolarity Infusion Site

D20-AAM16 1600 mOsm/L Central
D20-AAM30 1800 mOsm/L Central
D10-AAM16 1000 mOsm/L Peripheral or Central
D10-AAM30 1100 mOsm/L Peripheral or Central
20% Intralipid 260 mOsm/L Peripheral or Central

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