PHRM 221 Lecture Notes - Lecture 22: Alkaline Phosphatase, Bowel Resection, Elevated Transaminases
Document Summary
Occurs when acute provision of macronutrients (particularly carbohydrates) promote anabolism in patients who are malnourished. Starvation body switches from using cho to fat & protein as main energy sources. Reintroduction of cho (tpn) sudden shift back to glucose as main energy source. Leads to insulin surge anabolism intracellular shift of k, po4, mg. Start with 15-20 kcal/kg/day (50% of nutritional needs) Reduce cho and fat, okay to give full protein. Days 1, 2 (15 kcal/kg) d50w 200ml, aa 450ml, smof 100ml. Days 3, 4 (20 kcal/kg) d50w 300ml, aa 650ml, smof 100ml. Day 5+ (25 kcal/kg) d50w 400ml, aa 720ml, smof 150ml. Treatment give iv boluses of k, po4, mg. Prevention add extra k, po4, mg to tpn bag. Mildly elevated transaminase (ast, alt) and alkaline phosphatase (alp) levels usually occur. Include: pre-existing liver disease, sepsis , pre-existing malnutrition, extent of bowel resection, excess nonprotein calories, little or no oral intake , and duration on tpn.
