ABSTRACT
Parenteral nutrition (PN) has been a lifesaving procedure for patients with short gut syndrome, very-low-birth-weight infants, and certain other patients with gut failure. The modern era of PN began in the 1960s with the development of a technique to catheterize the central venous circulation and the demonstration that normal growth and development could be achieved in immature dogs fed exclusively with PN (Dudrick et al., 1968; Wilmore and Dudrick, 1968). The placement of a central venous catheter allowed the provision of hypertonic PN formulas that were rapidly diluted in the high-ow central vein. Prior to this time, the provision of PN was limited to isotonic formulas or modestly hypertonic formulas that could be infused through a peripheral vein. The principle limitations were the large uid volumes necessary to meet the nutritional needs of the patients leading to uid overload and the loss of peripheral venous access in patients who required prolonged support with PN. Considerable knowledge about the provision of PN has evolved over the past 50 years. There is now a multitude of commercial products, amino acids, carbohydrates,
Introduction .................................................................................................................................... 237 Water .............................................................................................................................................. 238 Energy Sources .............................................................................................................................. 238
Dextrose .................................................................................................................................... 239 Lipids......................................................................................................................................... 239 Glycerol ..................................................................................................................................... 241 Energy Utilization of Parenteral Carbohydrate Source ............................................................. 241
Protein Sources ..............................................................................................................................242 Standard Adult ........................................................................................................................... 243 Renal Failure ............................................................................................................................. 243 Hepatic Failure .......................................................................................................................... 243 Trauma/Stress ............................................................................................................................245 Pediatric.....................................................................................................................................246 Cysteine ..................................................................................................................................... 247 Glutamine .................................................................................................................................. 247 Dipeptides ................................................................................................................................. 247
Electrolytes and Minerals ..............................................................................................................248 Vitamins .........................................................................................................................................248 Trace Elements ...............................................................................................................................248
