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Parenteral Nutrition (Roles of PN Pharmacist (Compounding (Ensure optimal…

- - - - Physical & microbiological monitoring
      - Scheduled testing
      - Monitor cleaning
- - - - Water-soluble
        
        C, B (1/2/5/6/12), Folic acid, Niacin, Biotin
      - Lipid-soluble
        
        A,D,E,K
  - - - More balanced immune response
        
        Faster resolution in inflammation
    - - Increase lymphocytes proliferation - maintain immune system
      - Maintain gut integrity - reduce bacterial transduction
      - Insulin-mediated glucose regulation - counteracts hyperglycemia
      - Enhance heat shock protein
      - Increase glutathione synthesis - attenuates oxygen stress
  - - - Can stimulate endogenous insulin secretion - decrease hyperglycemia risk
      - Stimulate insulin-like GF release - thus stimulate growth
      - Prevent catabolism - to achieve positive nitrogen balance
    - - as secondary energy source
      - to deliver lipid-soluble vitamin
      - To prevent essential fatty acid deficiency
    - - Stored in liver & skeletal muscle - as glycogen
      - Source of energy - CHO supplied as glucose
- - - - Advantages
        
        Reduced costs - iv tubing, syringes & connectors
        
        Ease of admin
        
        Nutrient - better utilized & assimilated
        
        Reduced rate of metabolic complications
        
        Decrease monitoring cost
        
        Cost-saving (preoaration, handling & delivery)
      - Moreover
        
        Substitute glucose with fat
        
        reduced risk of adverse effects a/w excessive glucose
        
        Addition of fat emulsion
        
        reduces vein irritation
        
        by decreasing osmolarity of nutrition formula
        
        This allows administration via peripheral vein
  - - - Nutriflex
      - Kabiven