The size and number of the nutrient particles in a solution define its osmolality. General purpose formulas have osmolalities between 300-700 mOsm, which is close to the osmolality of body fluids. Osmolalties of nutrient-dense formulas are higher, ranging from 400-700 mOsm. Hydrolyzed formulas are as high as 900 mOsm per kg of water. A solution’s tendency to shift from one fluid compartment to another across a semi permeable membraneIn Enteral formulas, osmolality is determined by the concentration of sugars, amino acids and electrolytesRange:300-700 milliosmoles per kilogramIsotonic:osmolality similar to blood(300mOsm/kg)Hypertonic:osmolality greater than blood(>300mOsm/kg)Hydrolyzed formulas:are higher in osmolality than standard formulas.Administration of Medication to the Tube Fed Patients:If possible, administer drugs in liquid formAdminister crushed tablet only when no other alternative is availableCrush the tablet to a fine powder and mix with water.Administer each drug separately.Flush the tube with at least 30ml water before giving the medicine.If the medication is ordered to be added to the feeding observe the feeding after addition for any reaction or precipitation.Parenteral Nutrition Support: Parenteral Nutrition is the intravenous infusion of dextrose, aminoacids, Lipids, vitamins and minerals through a central or peripheral route.Route of Administration:
Basic Ingredients of TPN Prescription: TPN (Central PN) is a concentrated formula which is hyperosmolar and must be developed into central vein. TPN provides:Carbohydrates in the form of glucoseProteins in the form of amino acidsLipids in the form of triglyceridesElectrolytes, vitamins and minerals.Parenteral Solutions:Combination Feedingcan be used as a bridge between parenteral and enteral (oral) nutrition in patients whose clinical status does not warrant full enteral nutrition, but whose nutritional status is best managed with only some form of enteral nutrition.