Outline how you would initiate a regime for Total Parenteral Nutrition in a critically ill septic malnourished 60kg man.
Central venous access;
Mixture of Protein, Fat and Carbohydrate, low amounts and slowly building up as tolerated;
electrolytes supplementation (especially at the start to prevent refeeding syndrome);
supplemental vitamins, trace elements;
monitoring of clinical state, electrolytes, LFTs, BSL,
Commencement of TPN, and the calculations of daily intake requrements relevant to this topic are discussed elsewhere. The specific chapters of greatest interest are:
This question closely resembles Question 7 from the first paper of 2015, where TPN prescription was re-explored. Like Question 7 , this question was not about the need or indication for TPN, nor was it asking the candidates to debate the relative merits of parenteral and enteral routes of nutrition. The decision was made for the candidates: TPN is required.
In short, the approach should resemble the following:
Culebras, Jesus M., et al. "Practical aspects of peripheral parenteral nutrition."Current Opinion in Clinical Nutrition & Metabolic Care 7.3 (2004): 303-307.
Singer, Pierre, et al. "ESPEN guidelines on parenteral nutrition: intensive care."Clinical Nutrition 28.4 (2009): 387-400.