Standard solution

Amino acid sln (Aminosyn) 7-10% 500 mL

Dextrose 40-70% 500 mL

Sodium 35 mEq

Potassium 36 mEq

Chloride 35 mEq

Calcium 4.5 mEq

Phosphate 9 mmol

Magnesium 8.0 mEq

Acetate 82-104 mEq

Multi-trace element formula 1 mL/d

(Zn, copper, manganese, chromium)

Regular insulin (if indicated) 10-60 U/L

Multivitamin(12)(2 amp) 10 mL/d

Vitamin K (in solution, SQ, IM) 10 mg/week

Vitamin B12 1000 mcg/week

Selenium (after 20 days of continuous TPN) 80 mcg/d

Intralipid 20%, 500 mL/d IVPB; infuse in parallel with standard solution at 1 mL/min for 15 min; if no adverse reactions, increase to 100 mL/hr once daily or 20 mg/hr continuously. Obtain serum triglyceride 6h after end of infusion (maintain <250 mg/dL). Cyclic Total Parenteral Nutrition: -12h night schedule; taper continuous infusion in morning by reducing rate to half of original rate for 1 hour. Further reduce rate by half for an additional hour, then discontinue. Finger stick glucose q4-6h; restart TPN in afternoon. Taper at beginning and end of cycle. Final rate of 185 mL/hr for 9-10 h and 2 hours of taper at each end for total of 2000 mL. Peripheral Parenteral Supplementation: -3% amino acid sln (ProCalamine) up to 3 L/d at 125 cc/h OR -Combine 500 mL amino acid solution 7% or 10% (Aminosyn) and 500 mL 20% dextrose and electrolyte additive. Infuse at up to 100 cc/hr in parallel with:

-Intralipid 10% or 20% at 1 mL/min for 15 min (test dose); if no adverse reactions, infuse 500 mL/d at 21 mL/h over 24h, or up to 100 mL/h over 5 hours daily.

-Draw triglyceride level 6h after end of Intralipid infusion.

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