TPN clinical question

[rxforlife2004]

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I'll make this very brief...Imagine u have this pt on TPN with lab as follow:

BUN/Scr : 20/2.4
AST: 24
ALT: 12
ALKP: 154
Amylase: 54
Lipase: 34
NH3 : 174

89 yr old male, Ht: 66 inches Wt: 65KG
Y-lytes = WNL

The problem is pt has both renal vs liver problem on going (acute renal vs .acute liver prob). Now, u can choose either Nephramine or Hepatamine as amino acid for this patient. Which one would you pick and why?
This is a true case...

Btw, Intake and Output is somewhat balanced

 

[Praziquantel86]

I'll make this very brief...Imagine u have this pt on TPN with lab as follow:

BUN/Scr : 20/2.4
AST: 24
ALT: 12
ALKP: 154
Amylase: 54
Lipase: 34
NH3 : 174

89 yr old male, Ht: 66 inches Wt: 65KG
Y-lytes = WNL

The problem is pt has both renal vs liver problem on going (acute renal vs .acute liver prob). Now, u can choose either Nephramine or Hepatamine as amino acid for this patient. Which one would you pick and why?
This is a true case...

Btw, Intake and Output is somewhat balanced

Why would you need to use the specialty formulations in either case? The current guidelines (however weakly) recommend the use of standard formulations in most situations, unless it is a long-standing hepatic issue. I would just attempt to limit the fluid volume and go with a more concentrated formulation (Aminosyn II), if possible.

 

[njac]

Why is he on tpn?

Lactulose enemas for that ammonia... Sorry nurse friends!

 

[rxlea]

I just prepared a lactulose enema for a patient. I cannot imagine holding a liter of lactulose/sodium chloride in my butt that long.

 

[rxforlife2004]

Why is he on tpn?

Lactulose enemas for that ammonia... Sorry nurse friends!

on TPN because he could not eat for the past 4 days and mainly, the physician ordered "TPN per pharmacy"!!! Pt also had a small bowel resection, too...

Back to the case, i decided to go with nephramine vs, hepatamine. He's already been on lactulose, too. I also had a talk with an internist and he agreed that's the way to go...

 

[njac]

TPN per pharmacy is not indication enough. If you're good you can get about 50% of your TPNs d/c'd.

Although somehow I've got 6 this week.

 

[rxforlife2004]

TPN per pharmacy is not indication enough. If you're good you can get about 50% of your TPNs d/c'd.

Although somehow I've got 6 this week.

I agree with you. However, the MDs are the ones that make the call whether to D/C or continue TPN since it's their patients. You might recommend to D/C, but it's still their decisions to make. Also ,it depends from hospital to hospital. At my hospital (private hospital), MDs have a lot of autonomy.