Requirements of Nutrients

Nutrient Requirements
Nutritional needs of each patient must be determined independently to support the type of diet. In most cases, solutions can be interpreted the same nutritional value for the delivery by the enteral and parenteral routes, but differences in the absorption must be considered. A complete nutritional support solution must contain water, energy, amino acids, electrolytes, vitamins, minerals and essential fatty acids.
Water
In most patients, the need for water by 1500 will ml ml for the first 20 kg body weight plus 20 per kilogram on 20th Additional losses would occur because they are replaced. For adult patients of average size, must be fluid 30-35 ml / kg, about 1 ml is needed / kcal of energy.
Energy
The energy may be replaced by one of three ways: (1) with the standard equations for the calculation of the additional calories for BEE activity and disease, (2) by the application of a simple calculation based on estimates of calories per kilogram of body weight, or (3) by measuring the energy consumption by indirect calorimetry. BEE can be estimated by the Harris-Benedict equation: for men, BEE = 666 + (13.7 x body weight in kg) + (5 x height in cm) - (6.8 x age in years). For women, BEE = 655 + (9.5 x body weight in kg) + (1.8 x height in cm) - (4.7 x age in years). For patients who suffer from malnutrition, the actual weight must be used, because obese patients, the ideal body weight should be used. For most patients, an increase of 20-50% is administered to the BEE in non-protein calories to meet energy expenditure during activity or in connection with the disease. Some patients are considered energy expenditures of more than 150% BEE have. Energy demand can be estimated in kilograms (for obese patients, ideal weight by multiplying the actual body weight) of 30-35 kcal. Both methods provide imprecise estimates of the actual energy consumption, especially for the clearly inadequate, overweight and severely ill patients. Studies with indirect calorimetry have shown that 30-40% of patients were measured spending by 10% above or below the estimates. For the accurate estimation of energy expenditure, indirect calorimetry should be used.
Protein
Protein and energy requirements are closely linked. If sufficient calories are provided, most patients from 0.8 to 1.2 g protein per kg / day are administered. should be given to patients with moderate to severe stress, up to 1.5 g / kg / d. How to meet the energy demand in need for the actual weight of normal and underweight patients and weight ideal for use in patients with severe obesity. Patients receiving adequate calories, protein catabolism without protein for energy instead of protein synthesis. So, when energy intake is lower, excess protein for nitrogen balance is needed. When the energy and protein intake are low, additional energy have a significant positive nitrogen balance on additional proteins.
Electrolytes and minerals
Need for sodium, potassium and chloride are very variable. Most patients require 45-145 mEq / d each. The real needs of patients depend on individual patient's cardiovascular, renal, endocrine, gastrointestinal tract and the status and activities of the serum. Patients, enteral nutrition should support the proper vitamins and minerals as the recommended daily intake. Most solutions premixed enteral sufficient vitamins and minerals are used as sufficient calories. Patients, parenteral nutrition support needs small amounts of minerals: calcium, 10-15 mEq / d, P, 15-20 mEq per 1,000 non-protein calories, and magnesium, 16-24 mEq / d. The majority of patients, the nutritional support did not need extra iron, because the body stores are adequate. Iron nutrition must closely by the concentration of hemoglobin can be monitored, MCV and studies of iron. Parenteral administration of iron is associated with a number of side effects and should not take iron deficiency in patients with oral iron can be reserved. Patients, parenteral nutrition should support the trace elements zinc (5 mg / d) and copper (about 2 mg / d). The patients suffer from diarrhea, it will take more zinc to replace fecal losses. Other trace elements, especially chromium, manganese and selenium are patient, long-term parenteral nutrition provided. Parenteral vitamins are provided daily. Multivitamin standardized solutions are currently available, to provide adequate amounts of vitamins A, B12, C, D, E, thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, folic acid, biotin. Vitamin K is not automatic, but administered if the prothrombin time is abnormal.