ADA Dietary Guidelines for DM: CHO: 55 – 60% of total cal, protein: 15 – 20% of total cal, fat (total): <30% of total cal (saturated: <10, poly: <10%, mono: 10 – 15%). Protein: 0.8 g/kg/d fiber: 35 0 40 g/d – 50% coming from sol. Fibers like beans, lentils, oat, guar gum; chol: <300 mg/d, sodium: <3000 mg/d
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Renal Diet: 2 gm Na, 2 gm K, 800 mg phosphate, 60 gm protein, and fluid restriction 1 liter/day.
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Nitrogen Balance
N input = protein gms in 24h/6.25
N output = 24 h UUN + 4 g/d
2 L TPN in 24 h with 27.5 g synthetic amino acid protein sol/L and voided 22.5 dL urine per 24 h with UUN = 66 mg/dL.
Ninput = 2 * 27.5 = 55 g/24 h
55/6.25 = 8.8 gm of protein
Noutput = 22.5 * 66 = 1485 mg or 1.5 g.
1.5+4=5.5g
Nbal = 8.8-5.5=3.3g nitogen
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PEG TF
PEG tube. Goal: 60 cc/hr ATC. Start at 20 - 30 ml/hr, advance by 10 ml/hr q6h until goal (60 ml/hr) is reached. Check TF residual q4hrs and hold for 2 hrs, if residue >100 cc, or N/V/D occurs. Flush with water 10 cc qid. Add free H20 300 ml qid. Flush tube with 5 ml between each med pass.
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Techniques to unclog PEG-T
- Flushing with 30 - 60 ml warm H20 with Viokase powder (pancreatic enzyme. Use small volume syringe (10 ml)
- Avoid pill fragments and thick viscous liquids