Figure 1832

Parenteral solutions. Standard solutions are available with amino acids, glucose, and lipids plus added vitamins, trace elements, and electrolytes contained in a single bag ("total admixture" solutions, "all-in-one" solutions). The stability of fat emulsions in such mixtures should be tested. If hyperglycemia is present, insulin can be added to the solution or administered separately.

To ensure maximal nutrient utilization and avoid metabolic derangements as mineral imbalance, hyperglycemia or blood urea nitrogen rise, the infusion should be started at a slow rate (providing about 50% of requirements) and gradually increased over several days. Optimally, the solution should be infused continuously over 24 hours to avoid marked derangements in substrate concentrations in the presence of impaired utilization for several nutritional substrates in patients with acute renal failure. EAA, NEAA—essential and nonessential amino acids; TPN—total parenteral nutrition.

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