Calories in

iv feeding
(Dextrose)
ODESSA S. BUGARIN, MAN
INSTRUCTOR
 DEXTROSE is a prescription sterile, non-
pyrogenic solution for fluid replenishment
and caloric supply for intravenous and/or
oral administration and as treatment of
low blood sugar (hypoglycemia).
O Dextrose is available under the following
different brand names: D50W,
DGlucose, and Glucose
O Intravenous solution
(2.5%, 5%, 10%, 20%, 30%, 50%, 70%)
Dextrose is produced from:
O Carbon Dioxide
O H2O
O Adenosine Triphosphate (ATP)

Functions of DEXTROSE:
1. For DM (hypoglycemia)
2. Calories for those who have illness
3. Alcohol Intoxication
4. Treat hyperkalemia
S/E of Dextrose consumption:
I.) Allergic Rxn:
* DOB
* fever
*sweating, pale skin
* Swelling of face, lips, tongue or throat
* redness, swelling, warmth at the IV site
* confusion
* light-headedness
II.) Common S/E:
* pain or tenderness post injection
* flushing (warmth, redness, tingly feeling of IV site)
 Calculation of Dextrose Calories
 Calculate grams of dextrose:
Multiply the total volume of dextrose sol’n.
(in ml) supplied in a day by the dextrose
concentration. This gives you grams of dextrose
supplied in a day.
 Multiply the grams of dextrose by 3.4
(there are 3.4 kcal/g dextrose) to
determine kcal supplied by dextrose in a
day
Example:

D10 (10% dextrose) 1 Liter for 12 H

1000 cc x 0.10 = 100cc x 3.4 = 340 kcal (12 H)

680 kcal (24 H)

D50 W (50% dextrose) 1 Liter

1000 ml x 50g/100ml = 500g
or 1000 ml x 0.50 = 500
500 x 3.4 kcal/g = 1700 kcal
 Macronutrient Concentrations in
Parenteral Nutrition (PN)Solutions
 Macronutrient concentrations (%) = the
grams of solute/100 ml of fluid
 D70 has 70 grams of dextrose per 100
ml.
 10% amino acid solution has 10 grams
amino acids/100 ml of solution
 20% lipids has 20 grams of lipid/100 ml
of solution
 Protein Content Calculations
 To calculate the grams Example Protein
of protein supplied by a Calculation
TPN solution, multiply  1000 ml of 8% amino
the total volume of acids:
amino acid solution (in  1000 ml x 8 g/100
ml*) supplied in a day ml = 80g
by the amino acid
 Or 1000 x .08 = 80 g
concentration.
 DIET
THERAPY
Diet Therapy aims:
O Maintains normal nutrition
O Corrects nutritional deficiency
O Changes body weight
O Adjusts the body’s ability to use
one or more nutrients
O Permits maximum rest to the
body or an organ
 Standard Hospital Diets
I. Liquid Diets
a) Clear Liquid Diet
b) Full Liquid Diet
II. Soft Diet
a) Low-residue diet
b) High-fiber diet
c) Low Salt- Low Fat diet
d) Diabetic diet
III. Regular diet
IV. Test Meals
a) Fecal Fat Determination test
b) Meat-free test
c) Calcium test
d) Serotonin test
I. Liquid Diets
a) Clear Liquid Diet (used for 24-48 H post
vomiting, diarrhea, or surgery); (like tea,
fat-free broth, fruit ices, ginger ale, fruit
juices & water gruels); except carbonated
and non-dairy fluids
b) Full Liquid Diet (used for acu. infections,
short duration fever & too ill pts. &
offered in 6 feedings or more); (liquids +
foods that liquefy at BT); (Ex. Strained
meat added to broth--- veg. puree; soft
custard, plain gelatin, plain ice cream,
milk & choco. malted milk)
II. Soft Diet (used in acu. infections, fevers, GIT disturbances and before
a dx procedure; with reduced fiber content, bland flavor, soft consistency)

Restricted diets :
a) Low-residue diet (It limits high-fiber foods, like whole-grain breads
and cereals, nuts, seeds, raw or dried fruits, and vegetables);
(food sources- - - enriched white breads, plain crackers, white
rice, noodles, well-cooked fresh vegetables or canned vegetables
without seeds, ripe bananas, avocado, clear jelly, honey, syrup,
ice cream and ice pops, plain cakes and cookies, decaffeinated
coffee, tea, & juices without seeds or pulp)

b) High-fiber diet (A plant based carbohydrate that is not easily

digestible and can provide feelings of fullness after eating
without spiking blood sugar or adding too many extra calories.
Fibrous foods often need extra chewing, which can also increase
satiety).
3 most important kinds of Dietary Fiber are:

1) Insoluble - helps with digestive health and regularity,

fiber comes from the walls of plant cells and doesn't
dissolve in water or ferment in the colon like soluble
fiber. It is found in whole grains, the skin of fruits that
grow on trees, and many green vegetables.
2) Soluble - "Good" bacteria in the colon use this kind of
fiber as a food source, and it may help control blood
sugar levels in people with diabetes. Fibers found in
most plants (legumes and beans, root vegetables, many
fruits, and some grains, such as oats and barley)
3) Prebiotic - soluble fiber (called inulin or fructan) found
in asparagus, onions, garlic, leeks, bananas, and some
root vegetables, as well as in certain grains. This fiber is
also a food source for good gut bacteria.
c.) Low Salt- Low Fat/ DASH (Dietary Approaches to Stop Hypertension)
- low-sodium foods and nutrients that are believed to lower
blood pressure, like potassium, magnesium, calcium, protein
and fiber. It limits foods that are high in sodium, saturated fat
and added sugars.
- diet limits sodium to 2,300 mg a day (1 tsp. of table salt)
*** Low-calorie diet is a structured eating plan that restricts
daily caloric intake, commonly for weight loss (consuming
around 1,200 to 1,500 calories per day, which creates a
calorie deficit that can lead to weight loss).

d.) Diabetic Diet - naturally rich in nutrients and low in fat and calories.
Key elements are fruits, vegetables, whole grains, healthy
carbohydrates, fiber-rich foods, fish and "good" fats. In fact, a
diabetes diet is the best eating plan for most everyone.
 Glycemic index (GI) is a rating system for foods containing CHO. It
shows how quickly each food affects your blood sugar (glucose) level
when that food is eaten on its own.
High-glycemic Index O Low-glycemic Index
O Foods that are quickly O Foods which cause blood
digested and absorbed, sugar levels to rise and fall
causing a rapid rise in slowly, may help feel fuller
blood sugar for longer.
O Examples of High GI foods: O Examples of Low-GI foods:
* sugar and sugary foods * vegetables, beans,
* sugary soft drinks * low-fat dairy, berries,
* white bread
* whole grains
* potatoes
* lean proteins (tofu,
* white rice
chicken, fish)
III. Regular diet
O also called general, normal or full diet, is formerly
named DAT (diet as tolerated). A regular diet typically
combines a variety of grains, vegetables, fruits, dairy
products, and meat, fish and beans. Designed for the
adult patient (ambulatory) who does not need any
dietary modification/ restrictions for therapeutic
purposes.

O Sample Menu
- Fresh Fruit in Season
- Scrambled Egg
- Rice or bread with butter/margarine or jam
- Coffee, Tea or Chocolate
 IV. Test Meals
a) Fecal fat determination test – measures fat globules in
stools to detect fat absorption as in cases like cystic fibrosis.
It consists of 100 g Fat ingested daily for 3 days prior to
stool collection. Food items included are as follows: 2 cups
whole milk, 1 egg, 8 oz. lean meat, 10 exchanges of fat
b) Meat- free test – used to determine GIT bleeding. A 3-day
diet excludes ingestion of meat, poultry, & fish.
c) Calcium test – used to determine urinary calcium excretion
to dx hypercalciuria. The diet requires 1,000 mg calcium
intake – 400 mg from sources & 600 mg from oral
supplements
d) Serotonin test – used to detect calcinoid tumors of the
intestinal tract. Food rice in serotonin is excluded in the diet
The Normal diet (Regular Diet) may be
modified for:

o Consistency and texture

o Flavor
o Energy value
o Nutrient level such as fats, CHON, CHO,
Na & others (per dietitians food plan)
o Food categories such as types of fats or
elimination diet for allergies
(hypoallergenic diet)
Routes of Nutrition
Support
OEnteral Nutrition
OParenteral Nutrition
 Enteral Feeding
O nutrition taken through the mouth or
through a tube that goes directly to
the stomach or small intestine (GIT---
Mouth, Esophagus, Stomach, and
Intestines).
O Intended for a condition or injury that
prevents eating a regular diet by
mouth, but their GI tract is still able to
function.
 Blenderized Tube Feeding (BTF)
- The use of pureed or “blended” foods and liquids given directly via the
feeding tube. Blenderized feeds could refer to homemade BTF,
commercial formula mixed with pureed baby food or any of the variety
of commercially available ready to use BTFs.
- Some options include making blenderized feeds at home, use of a
commercial blenderized tube feeding formula or a combination of
blended foods (commercial or homemade) with a traditional
commercial formula.

*** before feeding make sure to position client in sitting position/ HFP
*** measure residual every 4H & aspirate the gastric residual volume
(not more than 200ml)/ For adults only – inject 10-20ml of air into the
tube using a 60ml syringe. For children – inject 1 -5ml of air into the tube
using a 60ml syringe. Wait 15-30 minutes before trying again.
*** Always flush at least twice a day and before, between, and after
giving medications through the NG tube, at least 20-30 ml between each
medication or feeding, every 4-6H.
The main types of Enteral feeding :
•Nasogastric tube (NGT) starts in the nose and ends in the
stomach.
•Orogastric tube (OGT) starts in the mouth and ends in the
stomach.
•Nasoenteric tube starts in the nose and ends in the intestines
(subtypes include nasojejunal and nasoduodenal tubes).
•Oroenteric tube starts in the mouth and ends in the intestines.
•Gastrostomy tube is placed through the skin of the abdomen
straight to the stomach (PEG - percutaneous endoscopic
gastrostomy).
•Jejunostomy tube is placed through the skin of the abdomen
straight into the intestines (PEJ - percutaneous endoscopic
jejunostomy)
 Complications:
1. MECHANICAL
- Nasopharyngeal irritation (ice chips, topical anesthetic, &
decongestants); Luminal obstruction (flush: replace tube); Mucosal
erosions (reposition tube; ice water lavage; remove tube); Tube
displacement (replace tube); Aspiration pneumonia (d/c tube fdg.)
2. GASTROINTESTINAL
- Cramping/Distention (change formula; reduce infusion rate);
Vomiting/Diarrhea (dilute formula; reduce infusion rate; anti-diarrheal
agents); Constipation (promote sufficient fluids & fibers; encourage
patient activity)
3. METABOLIC
- Hypertonic dehydration (increase free water); Glucose intolerance
(reduce infusion rate; give insulin); Cardiac failure (reduce sodium
content; fluid restriction); Renal failure (decrease P, Mg, K, CHON
restriction, essential amino acid solution); Hepatic encephalopathy
(decrease amount of CHON)
OGT tube
 PARENTERAL FEEDING
O Parenteral feeding refers to liquid nutrition processed by the
veins. It’s considered riskier than enteral feeding, but often
results in improved health and energy.
O ROUTES:
O Peripheral Vein Route or Peripheral parenteral nutrition
(PPN)- (for mild-mod. nutritional deficiency; short-term
maintenance– NPO for 2 wks.; nutrition is supplied through
smaller veins that are less centrally located in the body)
O Parenteral Hyperalimenation (IVH) or Central Parenteral
Nutrition (CPN) or Total Parenteral Nutrition (TPN) is delivered
through a central vein — usually, the superior vena cava
located under your collarbone, which goes directly to the
heart. The larger central vein allows a larger catheter to
deliver higher concentrations of nutrition with higher calories.
Parenteral feeding/ Parenteral
Nutrition/ Intravenous Feeding

- a method of getting nutrition into the

body through the veins, which may include
CHON, CHO, fat, minerals and electrolytes,
vitamins and other trace elements for patients
who cannot eat or absorb enough food
through tube feeding formula or by mouth to
maintain good nutrition status.