CHAPTER 3


coconut oil, and soybean oil; therefore, allergies to these components must be considered when deciding on the use of an alternate ILE. When patients are unable to tolerate ILE or enteral fat for prolonged


periods of time, cutaneous application of sunflower or safflower oil has been proposed as an alternative to provide a source of essential fats.15 Because it is unclear whether the use of cutaneous oils can prevent EFAD, a serum triene-tetraene ratio should be measured. Changes to the serum triene-tetraene ratio can be apparent in as little as 7 to 10 days following restriction of essential fatty acid intake and usually precede the appear- ance of clinical signs and symptoms of EFAD, such as alopecia or eczem- atous dermatitis.9


EFAD following application of cutaneous oils.15 research demonstrated no benefit.16


Electrolytes


Electrolytes are added to PN formula to meet individual patient require- ments. Electrolyte requirements can vary greatly depending on body weight, organ function, degree of catabolism, presence of malnutrition, electrolyte losses, and medications , among other factors. Box 3.2 outlines typical daily IV electrolyte requirement ranges for adults.17


BOX 3.2 Daily Electrolyte Requirements for Adult Parenteral Nutrition17 Electrolyte


Calcium


Magnesium Phosphorous Sodium


Potassium Acetate Chloride


a


Standard daily requirementa 10 to 15 mEq 8 to 20 mEq


20 to 40 mmol 1 to 2 mEq/ kg 1 to 2 mEq/ kg


As needed to maintain acid-base balance As needed to maintain acid-base balance


Based on generally healthy people with normal losses.


Adapted with permission from Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28(6):S39-S70. doi:10.1177/0148607104028006s39 17


Early research appeared to demonstrate resolution of However, more recent


Therefore, every effort should be made to provide essential fatty acids via the oral or parenteral route.


36


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