Large Volume Parenterals

Large Volume Parenterals (LVPs)
These solutions are usually administered by IV infusion to replenish body fluids,

electrolytes, or to provide nutrition. They are usually administered in volumes of 100 mL
to liter amounts and more per day by slow intravenous infusion with or without
controlled-rate infusion systems
USES:
1. Employed as Maintenance therapy for the patient entering or recovering from
surgery, or for the patient who is unconscious and unable to obtain fluids,
electrolytes, and nutrition orally.
Maintenance Therapy
-
given to the patient being maintained on parenteral fluids only

several days, simple solutions providing adequate amounts of
water, dextrose and small amounts sodium and potassium
generally suffice.
Total Nutrient Admixtures also may be given (TNA) include all

substrate necessary for nutritional support (carbohydrates,
protein, fat, electrolytes, trace elements and others).
These admixtures are very useful for patients undergoing

chemotherapy, and for gastrointestinal patients, and anorexic
patients
2. Utilized as Replacement therapy in patients who have suffered a heavy loss

of fluid and electrolytes.
Replacement Therapy
-
given to the patient in which there is heavy loss of water and

electrolytes, as in severe diarrhea or vomiting, greater than usual
amounts of these materials may be initially administered and
maintenance therapy provided. Patients with Crohns disease,
AIDS, burn patients, or those experiencing trauma are candidates
for replacement therapy.
Water Requirement
-
The daily water requirement is that amount needed to replace

normal and expected losses. Normal requirement adult -25 to 40
mL/kg of body weight or an average of about 2,000 mL per square
meter of body surface area
Estimate guidelines in normal daily requirement for water

1. <10 kg: 100 mL/kg/day
2. 10-20kg: 1000 mL plus 50 mL/kg/day for weight over
10kg
3. >20 kg to maximum of 80 kg: 1500 mL Plus 20
mL/kg/day
for weight over 20 kg
Electrolyte Requirement
1. Potassium
important for cardiac and skeletal muscle function. The usual daily
intake is about 100 mEq and the usual daily loss is about 40 mEq
Potassium can be lost through: excessive perspiration, repeated

enemas, trauma (such as severe burns), uncontrolled diarrhea,
diseases of intestinal tract, surgical operations and others
Low potassium levels - Hypokalemia, can lead to death

Symptoms of potassium loss: weak pulse, faint heart sounds, falling
blood pressures & generalized weakness
Excess potassium is not good either: Hyperkalemia can cause kidney

failure
Symptoms: diarrhea, irritability, muscle cramps, and pain

2. Sodium
is vital to maintain normal extracellular fluids.

Average daily intake of sodium: 135 to 170 mEq (8 to 10 g of Sodium
chloride)
Sodium loss/deficit: 3 to 5 g sodium chloride (51 to 85 mEq of sodium)

is administered daily
Symptoms:
convulsions
excessive
sweating,
fatigue,
muscle
weakness,
Symptoms (excess): Dry, sticky mucous membranes, flushed skin,

elevated body temperature, lack of tears, and thirst
3. Chloride
the principal anion of the extracellular fluid usually paired with sodium.
Chloride is also important for muscle contraction, balancing the fluid
levels inside and outside the cells & maintaining the acid-base
balance of the extracellular fluid.
Caloric Requirements:
-
Basic caloric requirements may be estimated by body weight; in

the fasting state, the average daily loss of body proteins is
approximately 80g/day for a 70kg man.
Daily ingestion of at least 100 g of glucose reduces this loss by

half.
Generally, patients requiring parenteral fluids are given 5%

dextrose to reduce caloric deficit
*Parenteral hyperalimentation
This is the infusion of large amounts of basic nutrients sufficient to achieve active tissue
synthesis and growth. It is employed with a long term intravenous feeding of protein
solutions containing high concentration of dextrose (approximately 20%), electrolytes,
vitamins, and sometimes insulin.
Components of Parenteral Nutrition Solutions
Electrolytes
1. Sodium. 25 mEq
2. Potassium ... 20 mEq
3. Magnesium ..5 mEq
4. Calcium .5 mEq
5. Chloride .. 30 mEq
6. Acetate .. 25 mEq
7. Phosphate ..18 mM
Vitamins
1. Vitamin A 3300 I.U.
2. Vitamin D 200 I.U.
3. Vitamin E 10 I.U.
4. Vitamin C 100 mg
5. Niacin 40 mg
6. Vitamin B2 3.6 to 4.93 mg
7. Vitamin B1 3 to 3.35 mg
8. Vitamin B6 4 to 4.86 mg
9. Pantothenic Acid 15 mg
10. Folic Acid 400 mcg
11. Vitamin B12 5 mcg
12. Biotin 60 mcg
Amino Acids: Essential Amino Acids

1. L - Isoleucine..590 mg
2. L - Leucine .770 mg
3. L - Lysine acetate..870 mg
(free base.620 mg)
4. L - Methionine 450 mg
5. L - Threonine ..340 mg
6. L - Tryptophan 130 mg
7. L - Valine .560 mg
8. L - Phenylalanine ..480 mg
Nonessential Amino Acids

1. L - Alanine ..600 mg
2. L - Arginine .810 mg
3. L - Histidine .240 mg
4. L - Proline 950 mg
5. L - Serine .500 mg
6. Aminoacetic acid 1.19 g
Enteral Nutrition
Enteral nutrition products may be administered orally, via nasogastric tube, via feeding
gastronomy, or via needle-catheter jejunostomy.
These products are formulated to contain vitamins, minerals, carbohydrates, proteins,

fats and caloric requirements to meet specific needs of the patient.
The formula diets may be monomeric or oligomeric (amino acids or peptides and simple
carbohydrates) or polymeric (more complex protein and carbohydrates sources.
Examples:
Protein - ProMod Powder, Propac Powder
Carbohydrates - Moducal Powder
Fat - Lipomul Liquid
Fewer calories- Ensure HN, Sustacal, & Osmolite HN

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Large Volume Parenterals (LVPs)

These solutions are usually administered by IV infusion to replenish body fluids,

given to the patient being maintained on parenteral fluids only

Total Nutrient Admixtures also may be given (TNA) include all

These admixtures are very useful for patients undergoing

2. Utilized as Replacement therapy in patients who have suffered a heavy loss

given to the patient in which there is heavy loss of water and

The daily water requirement is that amount needed to replace

Estimate guidelines in normal daily requirement for water

Potassium can be lost through: excessive perspiration, repeated

Low potassium levels - Hypokalemia, can lead to death

Excess potassium is not good either: Hyperkalemia can cause kidney

Symptoms: diarrhea, irritability, muscle cramps, and pain

is vital to maintain normal extracellular fluids.

Sodium loss/deficit: 3 to 5 g sodium chloride (51 to 85 mEq of sodium)

Symptoms (excess): Dry, sticky mucous membranes, flushed skin,

Basic caloric requirements may be estimated by body weight; in

Daily ingestion of at least 100 g of glucose reduces this loss by

Generally, patients requiring parenteral fluids are given 5%

Components of Parenteral Nutrition Solutions

Amino Acids: Essential Amino Acids

Nonessential Amino Acids

These products are formulated to contain vitamins, minerals, carbohydrates, proteins,

Fewer calories- Ensure HN, Sustacal, & Osmolite HN

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