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Surgery

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General Surgery

Question
34 out of 142
 

During the first week intravenous hyperalim-entation all of the following can happen except:



A Weight gain
B Hyperglycemia

C Rise in blood urea-nitrogen
D Hypokalemia

Ans. A Weight gain (REF SCHWARTZ SURGERY 8TH EDN PG 37)

Metabolic Complications of Total Parenteral Nutrition

Problems

Possible Causes

Solutions

Glucose
1.Hyperglycemia, glycosuria, osmotic diuresis, hyperosmolar nonketotic dehydration and coma

1.Excessive total dose or rate of infusion of glucose; inadequate endogenous insulin; increased glucocorticoids; sepsis

1.Reduce amount of glucose infused; increase insulin; administer a portion of calories as fat emulsion

2. Ketoacidosis in diabetes mellitus

2.Inadequate endogenous insulin response; inadequate exogenous insulin therapy

2.Give insulin; reduce glucose input

3. Postinfusion (rebounD. hypoglycemia

3.Persistence of endogenous insulin production secondary to prolonged stimulation of islet cells by high-carbohydrate infusion

3.Administer 5%–10% glucose before infusate is discontinued

Fat
1.Pyrogenic reaction

Fat emulsion, other solutions

Exclude other causes of fever

2.Altered coagulation

Hyperlipidemia

Restudy after fat has cleared bloodstream

3.Hypertriglyceridemia

Rapid infusion, decreased clearance

Decrease rate of infusion; allow clearance before blood tests

Impaired liver function

May be caused by fat emulsion or by an underlying disease process

Exclude other causes of hepatic dysfunction

Cyanosis

Altered pulmonary diffusion capacity

Discontinue fat infusion

Essential fatty acid deficiency

Inadequate essential fatty acid administration

Administer essential fatty acids in the form of one 500 ml bottle of fat emulsion every 2–3 days

Amino Acids
Hyperchloremic metabolic acidosis

Excessive chloride and monohydrochloride content of crystalline amino acid solutions

Administer Na+ and K+ as acetate salts

Serum amino acid imbalance

Unphysiologic amino acid profile of the nutrient solution; differential amino acid utilization with various disorders

Use experimental solutions if indicated

Hyperammonemia

Excessive ammonia in protein hydrolysate solutions; deficiency of arginine, omithine, aspartic acid, or glutamic acid, or a combination of these deficiencies in amino acid solutions; primary hepatic disorder

Reduce amino acid intake

Prerenal azotemia

Excessive amino acid infusion with inadequate calorie administration; inadequate free water intake, dehydration

Reduce amino acid intake; increase glucose calories; increase intake of free water

Calcium and Phosphorus
Hypophosphatemia

Inadequate phosphorus administration; redistribution of serum phosphorus into cells or bones, or both

Administer phosphorous (≥ 20 mEq potassium dihydrogen phosphate/1,000 I.V. calories); evaluate antacid or calcium administration, or both

Hypocalcemia

Inadequate calcium administration; reciprocal response to phosphorus repletion without simultaneous calcium infusion; hypoalbuminemia

Administer calcium

Hypercalcemia

Excessive calcium administration with or without high doses of albumin; excessive vitamin D administration

Decrease calcium or vitamin D

Vitamin D deficiency; hypervitaminosis D

Inadequate or excessive vitamin D

Alter vitamin D administration

Miscellaneous
Hypokalemia

Potassium intake inadequate relative to increased requirements for protein anabolism; diuresis

Alter nutrient administration

Hyperkalemia

Excessive potassium administration, especially in metabolic acidosis; renal failure

Alter nutrient administration

Hypomagnesemia

Inadequate magnesium administration relative to increased requirements for protein anabolism and glucose metabolism; diuresis; cisplatin administration

Alter nutrient administration

Hypermagnesemia

Excessive magnesium administration; renal failure

Alter nutrient administration

Anemia

Iron deficiency; folic acid deficiency; vitamin B12 deficiency; copper deficiency; other deficiencies

Alter nutrient administration

Bleeding

Vitamin K deficiency

Alter nutrient administration

Hypervitaminosis A

Excessive vitamin A administration

Alter nutrient administration

Elevations in AST (formerly SGOT), ALT (formerly SGPT), and serum alkaline phosphatase

Enzyme induction secondary to amino acid imbalance or to excessive deposition of glycogen or fat, or both, in the liver

Reevaluate status of patient

General Surgery Flashcard List

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