Tailoring Parenteral Nutrition

Guidelines for Monitoring Parenteral Nutrition

When it comes to hospital malnutrition, every patient’s requirements will be different. Once parenteral nutrition (PN) is indicated, health care professionals can calculate nutrient requirements to optimize clinical nutrition therapy to the specific needs of the patient.

To meet each patient’s energy and protein requirements, it is important to consider the complete clinical picture. Energy intake during PN must be adjusted to the1:

  • Actual energy expenditure
  • Clinical situation of the patient
  • Nutritional goals based on nutritional status
     

Actual Energy Expenditure

Several equations are available to predict energy consumption. In clinical practice, the Harris and Benedict equation is the most commonly used to calculate resting energy expenditure (REE). Using this equation, height, body weight, gender and age are used to estimate an individual’s resting metabolic rate.2

 

Clinical Situation of the Patient

The patient’s clinical condition, e.g. in connection with surgery, but also due to e.g. infections, and underlying diseases must be assessed to adjust nutrition therapy. These conditions account for increased energy and protein requirements due to the metabolic stress response.3

 

Nutritional Goals Established with Regard to Nutritional Status

When calculating a patient’s energy and protein requirements, the established objectives of the nutrition therapy must be considered, including1:

 

  • Provision of energy and protein to prevent body wasting during acute illness
  • Recovery of muscle and energy stores during re-convalescence
  • Catch-up growth in children
  • Nutritional status/body mass index (BMI) in severe malnutrition or cachexia
     

Using these parameters, carefully tailored PN can support the clinical nutrition needs of patients, thereby fighting hospital malnutrition.

 

References
  • 1.Carpentier Y, Sobotka L. Energy. In: Sobotka L, editor. Basics in Clinical Nutrition. Prague: Galen 2011;247-51.
  • 2.Westerterp KR, Schols AMWJ, Singer P. Energy metabolism. In: Sobotka L, editor. Basics in Clinical Nutrition. Prague: Galen 2011;96-103.
  • 3.Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017;36:623-50.

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