Parenteral Nutritional Support 159
3
The recommendations on parenteral sub-
strate supply to stable patients are summarized
in table 1. In individual patients, other dosages
may be required, depending on the patients’ con-
dition.
W a t e r
Fluid needs vary markedly and must be adapted
to the individual patient’s condition. For exam-
ple, some renal or cardiac disorders require lower
water intakes, whereas higher intakes are needed
with enhanced fluid losses (e.g. due to fever, hy-
perventilation or diarrhoea, or from wounds or
fistulae). Monitoring of the fluid status is neces-
sary, considering the patient’s clinical status,
body weight and possibly water intake and excre-
tion, blood electrolytes, acid base status, haema-
tocrit, urine-specific gravity and urine electro-
lytes. The postnatal fluid supply should be gradu-
ally increased ( table 2 ).
Energy
Energy needs vary with physical activity, growth
and the possible need to correct malnutrition.
The energy supply can be adjusted based on for-
mulae for energy expenditure (see Chapter 1.3.2)
and during weight changes. Low energy supplies
induce failure to thrive, but excessive energy in-
take (‘hyperalimentation’) must also be avoided
because it may induce metabolic imbalances, liv-
er damage and a serious refeeding syndrome
particularly in severely malnourished patients
[4].
Amino Acids
Parenteral amino acid requirements are lower
than enteral needs because PN bypasses intestinal
amino acid uptake and utilization. Amino acid Ta b l e 1.
Recommended dosages for parenteral substrate supply to stable patients by age
Age group
Water, ml/kg
Energy,kcal/kg
Amino acidsg/kg
Glucose,g/kg
Lipids,g triglyceri-des/kg
Sodium,mmol/kg
Potassium,mmol/kg
Calcium, mmol/kg
Phosphorus,mmol/kg
Magnesium,mmol/kg
Preterm
140 – 160
110 – 120
1.5 – 4
18
up to 3 – 4
3 – 5 (–7)
2 – 5
Neonate (1st month)
140 – 160
90 – 100
1.5 – 3
18
up to 3 – 4
2 – 3
1.5 – 3
0 – 1 years
120 – 150 (max. 180)
90 – 100
1 – 2.5
16 – 18
up to 3 – 4
2 – 3
1 – 3
0 – 6 months: 0.87 – 12 months: 0.5
0.5
0.2
1 – 2 years
80 – 120 (max. 150)
75 – 90
1 – 2
1 – 3
up to 2 – 3
1 – 3
1 – 3
0.2
0.2
0.1
3 – 6 years
80 – 100
75 – 90
1 – 2
1 – 3
up to 2 – 3
1 – 3
1 – 3
0.2
0.2
0.1
7 – 12 years
60 – 80
60 – 75
1 – 2
1 – 3
up to 2 – 3
1 – 3
1 – 3
0.2
0.2
0.1
13 – 18 years
50 – 70
30 – 60
1 – 2
1 – 3
up to 2 – 3
1 – 3
1 – 3
0.2
0.2
0.1
Depending on the condition of the individual patient, different dosages may be required. Adapted from Koletzko et al. [3]. K
+ supplementation should usually start after onset
of diuresis. Chloride supply usually equals the sum of sodium and potassium supply.
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 158–162
DOI: 10.1159/000375190