{"id":1087,"date":"2024-07-01T10:00:42","date_gmt":"2024-07-01T13:00:42","guid":{"rendered":"https:\/\/www.nutrimedrj.com.br\/?p=1087"},"modified":"2024-07-04T14:08:31","modified_gmt":"2024-07-04T17:08:31","slug":"calculos-uteis-na-nutricao-parenteral","status":"publish","type":"post","link":"https:\/\/www.nutrimedrj.com.br\/index.php\/2024\/07\/01\/calculos-uteis-na-nutricao-parenteral\/","title":{"rendered":"C\u00e1lculos \u00fateis na Nutri\u00e7\u00e3o Parenteral"},"content":{"rendered":"<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1116\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/07\/nutricao-parenteral-1.png\" alt=\"\" width=\"1024\" height=\"460\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/07\/nutricao-parenteral-1.png 1024w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/07\/nutricao-parenteral-1-300x135.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/07\/nutricao-parenteral-1-768x345.png 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left;\"><b>COMPOSI\u00c7\u00c3O DA NP<\/b><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1091\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a1.png\" alt=\"\" width=\"802\" height=\"467\" \/><\/p>\n<p><span style=\"font-weight: 400;\">A NP pode ser composta por macronutrientes (amino\u00e1cidos &#8211; Aas, glicose e emuls\u00e3o lip\u00eddica &#8211; EL) e micronutrientes (vitaminas, oligoelementos e eletr\u00f3litos). Cada nutriente \u00e9 prescrito de acordo com as necessidades nutricionais individuais.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">De acordo com a presen\u00e7a de macronutrientes, a NP pode ser:<\/span><\/p>\n<ul>\n<li><b>2&#215;1<\/b><span style=\"font-weight: 400;\"> (dois em um): cont\u00e9m amino\u00e1cidos e glicose, sem lip\u00eddios.<\/span><\/li>\n<li><b>3&#215;1<\/b><span style=\"font-weight: 400;\"> (tr\u00eas em um): cont\u00e9m os tr\u00eas macronutrientes (Aas, glicose e EL)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">As doses dos macronutrientes, no r\u00f3tulo, s\u00e3o descritas em grama (g).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As doses de eletr\u00f3litos, s\u00e3o apresentadas em mEq e, mMol para o f\u00f3sforo.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>1.1 &#8211; Macronutrientes\u00a0<\/b><\/p>\n<p><b>1.1.1 Carboidratos<\/b><\/p>\n<p><span style=\"font-weight: 400;\">A Glicose \u00e9 o carboidrato utilizado como fonte cal\u00f3rica na NP e, \u00e9 o componente que mais contribui com a osmolaridade final da formula\u00e7\u00e3o.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Limite de osmolaridade para administra\u00e7\u00e3o de NP<\/b><b>1,2<\/b><b>:<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. Acesso venoso perif\u00e9rico &lt; 900 mOsm\/ L<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. Acesso venoso central \u2265 900 mOsm\/ L<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Usualmente prescrita em:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">g<\/span><\/li>\n<li><span style=\"font-weight: 400;\">g\/ kg<\/span><\/li>\n<li><span style=\"font-weight: 400;\">TIG (taxa de infus\u00e3o de glicose) ou VIG (velocidade de infus\u00e3o de glicose): trata-se da quantidade de glicose ofertada em mg\/ kg\/ min.<\/span><\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><b>Recomenda\u00e7\u00f5es\u00b3<\/b><b>:<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><b>Adulto\/ paciente cr\u00edtico: n\u00e3o ultrapassar 5 mg\/ kg\/ min<\/b><\/li>\n<li><b>Adulto est\u00e1vel: n\u00e3o ultrapassar 7 mg\/ kg\/ min<\/b><\/li>\n<li><b>Neonatologia: &lt; 14 &#8211; 18 mg\/ kg\/ min<\/b><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">A solu\u00e7\u00e3o mais utilizada em NP \u00e9 a Glicose 50%, mais concentrada, com maior quantidade de gramas por volume (50g de glicose a cada 100 mL).<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 80px;\"><b>Valor cal\u00f3rico:<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><b>1g glicose monoidratada = 3,4 kcal<\/b><b>\u2078<\/b><b>.<\/b><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>1.1.2 &#8211; Amino\u00e1cidos (Aas)<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Importante macronutriente que atua no processo de cicatriza\u00e7\u00e3o de feridas, na preven\u00e7\u00e3o da perda de massa muscular e, na manuten\u00e7\u00e3o do sistema imune.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Para a manuten\u00e7\u00e3o do estado nutricional, \u00e9 necess\u00e1rio o fornecimento de metas proteicas e cal\u00f3ricas. A fonte proteica utilizada em NP, s\u00e3o as solu\u00e7\u00f5es de amino\u00e1cidos, que\u00a0 podem ser prescritas em:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">g<\/span><\/li>\n<li><span style=\"font-weight: 400;\">g\/ kg\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Densidade cal\u00f3rica: 1g Aas = 4 kcal<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">As solu\u00e7\u00f5es dispon\u00edveis, atualmente, s\u00e3o:<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1093\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a3-e1719598706202.png\" alt=\"\" width=\"775\" height=\"324\" \/><\/p>\n<p><b>&#8211; Aas Totais 10% (Aminoven\u00ae10%):<\/b><span style=\"font-weight: 400;\"> uso adulto e pedi\u00e1trico <\/span><b>ACIMA DE 2 ANOS<\/b><span style=\"font-weight: 400;\">. Mistura balanceada de amino\u00e1cidos essenciais (43%) e n\u00e3o essenciais (57%)<\/span><span style=\"font-weight: 400;\">\u2074<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b>Aas Pedi\u00e1tricos 10% com Taurina:<\/b><span style=\"font-weight: 400;\"> uso neonatal e pediatria. T\u00eam como objetivo assemelhar-se ao aminograma plasm\u00e1tico de neonatos alimentados com leite humano ou ao perfil de amino\u00e1cidos do sangue de cord\u00e3o umbilical\u2074`\u2076<\/span><span style=\"font-weight: 400;\">. Aminoven Infant\u00ae\/ Fresenius &#8211; 52%\u00a0 Aas essenciais e 48% n\u00e3o essenciais<\/span><span style=\"font-weight: 400;\">\u2074<\/span><span style=\"font-weight: 400;\">. A sol. de Aas Ped 10% com taurina da Baxter, o Primene\u00ae, possui 47,5% de Aas essenciais e 24% de Aas ramificados<\/span><span style=\"font-weight: 400;\">\u2075<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><b>&#8211; Aas ramificados segundo Fischer 8% (Aminosteril N-Hepa\u00ae):<\/b><span style=\"font-weight: 400;\"> indicado nas formas graves de insufici\u00eancia hep\u00e1tica, com ou sem encefalopatia hep\u00e1tica. Pacientes com disfun\u00e7\u00e3o hepatocelular apresentam aumento nos n\u00edveis s\u00e9ricos de am\u00f4nia, altera\u00e7\u00e3o na rela\u00e7\u00e3o entre os diversos tipos de amino\u00e1cidos (redu\u00e7\u00e3o da concentra\u00e7\u00e3o de amino\u00e1cidos de cadeia ramificada \u2013 valina, leucina, isoleucina \u2013 e eleva\u00e7\u00e3o da concentra\u00e7\u00e3o de amino\u00e1cidos arom\u00e1ticos \u2013 tirosina, fenilalanina e triptofano \u2013 e de metionina). Al\u00e9m disso, estes pacientes s\u00e3o hipercatab\u00f3licos. Assim, os Aas segundo Fischer fornecem uma propor\u00e7\u00e3o elevada de amino\u00e1cidos de cadeia ramificada (42%) e, uma baixa propor\u00e7\u00e3o de amino\u00e1cidos arom\u00e1ticos (2%) e metionina<\/span><span style=\"font-weight: 400;\">\u2074<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><b>&#8211; Aas essenciais com Histidina 10% (Nephrotec\u00ae10%):<\/b><span style=\"font-weight: 400;\"> desenvolvida para fornecer as necessidades para s\u00edntese de prote\u00edna de pacientes com insufici\u00eancia renal aguda ou cr\u00f4nica, em di\u00e1lise ou n\u00e3o. Possuindo em sua composi\u00e7\u00e3o alto conte\u00fado de amino\u00e1cidos essenciais (56%) e semiessenciais (18%)<\/span><span style=\"font-weight: 400;\">\u2074<\/span><span style=\"font-weight: 400;\">. Fornece tirosina, amino\u00e1cido condicionalmente essencial na doen\u00e7a renal. Estudos recentes n\u00e3o demonstraram maior benef\u00edcio quando comparado ao uso da solu\u00e7\u00e3o de amino\u00e1cidos totais, portanto, a sua utiliza\u00e7\u00e3o tem sido reduzida<\/span><span style=\"font-weight: 400;\">\u00b9<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><b>&#8211; L-Alanil- L-Glutamina 20% (Dipeptiven\u00ae 20%)<\/b><b><span style=\"font-weight: 400;\">\u2074<\/span><\/b><b>:<\/b><span style=\"font-weight: 400;\"> dipept\u00eddeo intravenoso, que pode ser prescrito na NP, como parte de um regime de nutri\u00e7\u00e3o cl\u00ednica em pacientes em estado hipercatab\u00f3lico e\/ ou hipermetab\u00f3lico. A suplementa\u00e7\u00e3o de glutamina pode reduzir a mortalidade hospitalar e o tempo de interna\u00e7\u00e3o<\/span><span style=\"font-weight: 400;\">\u00b2<\/span><span style=\"font-weight: 400;\">. A L-Glutamina \u00e9 o amino\u00e1cidos livre mais abundante no plasma, substrato que atua em v\u00e1rias vias metab\u00f3licas como no metabolismo da glicose, na regula\u00e7\u00e3o do metabolismo da am\u00f4nia, na s\u00edntese de bases nitrogenadas (purina e pirimidina), \u00e9 precursora da glutationa e atua na modula\u00e7\u00e3o do fluxo de carbono e nitrog\u00eanio.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>L-Alanil- L-Glutamina 20%:\u00a0 20g em 100 mL<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. alanina 8,2 g\/ 100 mL<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. glutamina: 13,46g\/ 100 mL<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Possui 3,87g N\/ 100 mL<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">1.1.3 &#8211; <\/span><b>Emuls\u00f5es lip\u00eddicas (EL): <\/b><span style=\"font-weight: 400;\">indicadas como fonte de energia e de \u00e1cidos graxos essenciais.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As ELs presentam alta densidade cal\u00f3rica:<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. EL 10%: 1,1 kcal\/ mL ou 11 kcal\/ g<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>. EL 20%: 2 kcal\/ mL ou 10 kcal\/ g<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Nota:<\/b><span style=\"font-weight: 400;\"> as EL 20% possuem menor propor\u00e7\u00e3o de fosfolip\u00eddios (emulsificantes), clareamento mais eficiente de triglicer\u00eddeos e, menor ac\u00famulo de colesterol e lipoprote\u00ednas de baixa densidade.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Os \u00e1cidos graxos integrantes de emuls\u00f5es lip\u00eddicas (EL) estimulam ou inibem certas fun\u00e7\u00f5es imunol\u00f3gicas. As EL t\u00eam diferentes impactos sobre fun\u00e7\u00f5es leucocit\u00e1rias. A escolha mais adequada de EL para pacientes imunossuprimidos seria a com efeito imunologicamente neutro ou imunoestimulante.<\/span><\/p>\n<p><b>&#8211; TCL\/ TCM 20% (Lipovenos MCT\u00ae 20% ou Lipofundin\u00ae 20%)<\/b><b><span style=\"font-weight: 400;\">\u2074<\/span><\/b><b>:<\/b><span style=\"font-weight: 400;\"> cont\u00e9m 50% de triglicer\u00eddeos de cadeia longa (TCL: \u00f3leo de soja, fonte de \u00e1cidos graxos essenciais \u2013 AGE, rico em \u00e1cido linoleico, \u03c9-6 ou n-6) e 50% de triglicer\u00eddeos de cadeia m\u00e9dia (TCM: fonte de energia mais r\u00e1pida).\u00a0<\/span><\/p>\n<p style=\"padding-left: 400px;\"><b>Doses altas de n-6 podem comprometer o sistema imunol\u00f3gico, induzir a imunossupress\u00e3o e rea\u00e7\u00f5es inflamat\u00f3rias sist\u00eamicas, com aumento de mediadores pr\u00f3-inflamat\u00f3rios (ex.: prostaglandinas e leucotrienos).<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>&#8211; Soja\/ TCM\/ oliva\/ peixe 20% (SMOFLipid\u00ae 20%)<\/b><b><span style=\"font-weight: 400;\">\u2074<\/span><\/b><b>:\u00a0 uso adulto e pedi\u00e1trico, <\/b><span style=\"font-weight: 400;\">raz\u00e3o \u03c9-6\/ \u03c9-3 (1:2).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. Soja (30%): TCL, fonte de AGE poliinsaturados (\u00e1cido linoleico, \u03c9-6), propriedades pr\u00f3-inflamat\u00f3rias e na redu\u00e7\u00e3o da fun\u00e7\u00e3o imune.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. TCM (30%): clareamento mais r\u00e1pido e influ\u00eancia positiva sobre o sistema imune devido a quantidade reduzida \u03c9-6. Fonte de energia r\u00e1pida.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. Oliva (25%): rica em AG monoinsaturado oleico, \u03c9-9, efeito neutro sobre o sistema imune. Est\u00e1vel quanto a peroxida\u00e7\u00e3o lip\u00eddica.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. Peixe (15%): rica em AG poliinsaturados \u03c9-3 (especialmente eicosapentaen\u00f3ico \u2013 EPA e, docosahexaen\u00f3ico \u2013 DHA), com efeito antiinflamat\u00f3rio.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>&#8211; \u00d3leo de Peixe 10% (Omegaven\u00ae10%)<\/b><b><span style=\"font-weight: 400;\">\u2074<\/span><\/b><b>:<\/b><span style=\"font-weight: 400;\"> emuls\u00e3o que cont\u00e9m apenas \u00f3leo de peixe (OP), rica em AG poliinsaturados \u03c9-3 ou n-3 (especialmente eicosapentaen\u00f3ico \u2013 EPA e, docosahexaen\u00f3ico \u2013 DHA), com efeito antiinflamat\u00f3rio. Costuma ser utilizado associado a outra EL. O OP associado \u00e0 EL TCL\/TCM 20% demonstrou menor tempo de interna\u00e7\u00e3o em pacientes de UTI. Para efeitos imunomoduladores ideais utiliza-se a raz\u00e3o \u03c9-6\/ \u03c9-3, 1:2.<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"2\">\n<li><b> C\u00e1lculos<\/b><\/li>\n<\/ol>\n<p><b>2<\/b><span style=\"font-weight: 400;\">.<\/span><b>1 Macronutrientes: convers\u00e3o peso para volume<\/b><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1094\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a4-e1719599275232.png\" alt=\"\" width=\"789\" height=\"215\" \/><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">EL 20%: g x 5 = mL EL20%<\/span><\/li>\n<li><span style=\"font-weight: 400;\">EL 10%: g x 10 = mL EL 10%<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>2.2 C\u00e1lculo VCT (Valor Cal\u00f3rico Total)<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1095\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a5-e1719599485454.png\" alt=\"\" width=\"801\" height=\"276\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.3 Rela\u00e7\u00e3o calorias n\u00e3o proteicas por grama de nitrog\u00eanio: <\/b><span style=\"font-weight: 400;\">frequentemente utilizada na an\u00e1lise final da formula\u00e7\u00e3o de NP. Dependente da condi\u00e7\u00e3o cl\u00ednica e das necessidades de cada paciente.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Rel. Kcal n\u00e3o proteica : g N<\/b><b>2 <\/b><b>= <\/b><b>kcal carboidrato + kcal lip\u00eddio<\/b><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>G prote\u00edna\/ 6,25<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">A quantidade de nitrog\u00eanio, \u00e9 o valor obtido dividindo-se a quantidade de prote\u00edna prescrita por 6,25. O nitrog\u00eanio presente na prote\u00edna, equivale a 16% dela, portanto 100\/16 = 6,25.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.3 Eletr\u00f3litos<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Na NUTRIMED padronizamos a apresenta\u00e7\u00e3o \u00fanica para cada eletr\u00f3lito, com o objetivo de aumentar a seguran\u00e7a, prevenindo a possibilidade de troca de concentra\u00e7\u00e3o de insumos.<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1096\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a6-e1719599722307.png\" alt=\"\" width=\"744\" height=\"206\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a6-e1719599722307.png 885w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a6-e1719599722307-300x83.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a6-e1719599722307-768x213.png 768w\" sizes=\"(max-width: 744px) 100vw, 744px\" \/><\/p>\n<h6><span style=\"font-weight: 400;\">Tabela 4. Eletr\u00f3litos e apresenta\u00e7\u00f5es padronizadas na NUTRIMED.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/h6>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">A prescri\u00e7\u00e3o de eletr\u00f3litos, em NP, pode utilizar as unidades, conforme tabela abaixo:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. mEq<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<span style=\"font-weight: 400;\">. mEq\/ kg<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <span style=\"font-weight: 400;\">.mg\/ kg <\/span><span style=\"font-weight: 400;\">(op\u00e7\u00e3o de unidade para o c\u00e1lcio)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. mMol*<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <span style=\"font-weight: 400;\">.mMol*\/ kg<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <span style=\"font-weight: 400;\">* F\u00f3sforo<\/span><\/p>\n<p><span style=\"font-weight: 400;\">. mL <\/span><span style=\"font-weight: 400;\">(importante verificar a concentra\u00e7\u00e3o de cada eletr\u00f3lito ao prescrever por volume)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1097\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a7-e1719599920596.png\" alt=\"\" width=\"793\" height=\"337\" \/><\/p>\n<p>&nbsp;<\/p>\n<h6><span style=\"font-weight: 400;\">Tabela 5. Modelo prescri\u00e7\u00e3o NP, formul\u00e1rio Nutrimed.<\/span><\/h6>\n<p>&nbsp;<\/p>\n<p><b>Convers\u00e3o para mL<\/b><span style=\"font-weight: 400;\">: verificar a concentra\u00e7\u00e3o utilizada. Na Nutrimed:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">NaCl: mEq\/ 3,4 = mL NaCl<\/span><\/li>\n<li><span style=\"font-weight: 400;\">AcNa: mEq\/ 2 = mL AcNa<\/span><\/li>\n<li><span style=\"font-weight: 400;\">KCl: mEq\/ 1,34 = mL KCl<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Gl. Ca: mEq\/ 0,46 = mL Gl. Ca e, mg\/ 100 = mL Gl. Ca\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">S. Mg: mEq\/ 0,81 = mL S. Mg<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Fosfato de Pot\u00e1ssio (inorg\u00e2nico) 1 mL = 1,1 mMol P , 2 mEq K<\/span><span style=\"font-weight: 400;\">+<\/span><\/li>\n<li><span style=\"font-weight: 400;\">F\u00f3sforo org\u00e2nico ou glicerofosfato de s\u00f3dio (Glycophos\u00ae\/ Fresenius): <\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">mMol P = mL<\/span><\/li>\n<li><span style=\"font-weight: 400;\">mEq Na<\/span><span style=\"font-weight: 400;\">+<\/span><span style=\"font-weight: 400;\"> = mL x 2\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Glicerofosfato de s\u00f3dio (C<\/b><b>3<\/b><b> H<\/b><b>7<\/b><b> Na<\/b><b>2<\/b><b> OP x H20) 1 mL = 1 mMol P e 2 mEq de Na<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Iniciar o c\u00e1lculo pela quantidade de F\u00f3sforo e, a fonte selecionada (org\u00e2nico ou inorg\u00e2nico), descobrir o volume de fosfato e associar a quantidade de K<\/span><span style=\"font-weight: 400;\">+<\/span><span style=\"font-weight: 400;\"> ou Na<\/span><span style=\"font-weight: 400;\">+<\/span><span style=\"font-weight: 400;\"> carreada.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Descontar a quantidade do c\u00e1tion carreado pelo f\u00f3sforo da qtdd total, o restante dever\u00e1 ser ofertado sobre a forma de cloreto ou acetato.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Buscar o equil\u00edbrio \u00e1cido-b\u00e1sico, ou seja, distribuir os c\u00e1tions, Na<\/span><span style=\"font-weight: 400;\">+ <\/span><span style=\"font-weight: 400;\">e K<\/span><span style=\"font-weight: 400;\">+<\/span><span style=\"font-weight: 400;\">, com valores iguais ou pr\u00f3ximos entre Cl<\/span><span style=\"font-weight: 400;\">&#8211;<\/span><span style=\"font-weight: 400;\"> e Ac<\/span><span style=\"font-weight: 400;\">&#8211;<\/span><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Seguir com os c\u00e1lculos para C\u00e1lcio e Magn\u00e9sio.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>2.4 Rela\u00e7\u00e3o C\u00e1lcio e F\u00f3sforo<\/b><b>\u2076`\u2077<\/b><b>: 1,3 \u2013 1,7: 1 (para Neonatologia)<\/b><\/p>\n<p><span style=\"font-weight: 400;\">A transfer\u00eancia de c\u00e1lcio e f\u00f3sforo durante a gesta\u00e7\u00e3o ocorre, principalmente, no terceiro trimestre.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">O objetivo da suplementa\u00e7\u00e3o de C\u00e1lcio e F\u00f3sforo na NP \u00e9, ofertar quantidades que estimulem o metabolismo celular positivamente, resultando na mineraliza\u00e7\u00e3o \u00f3ssea.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>1,7 : 1 (mg Ca : mg P)<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Rela\u00e7\u00e3o mais pr\u00f3xima \u00e0s quantidades observadas no meio intrauterino, permitindo maior reten\u00e7\u00e3o dos \u00edons e diminui\u00e7\u00e3o da excre\u00e7\u00e3o urin\u00e1ria de f\u00f3sforo, promovendo a mineraliza\u00e7\u00e3o \u00f3ssea<b>\u2077<\/b><\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><b>2.4.1 . C\u00e1lcio Elementar:<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Gl. de C\u00e1lcio 0,46 mEq\/ mL<\/span><\/li>\n<\/ul>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>1mL &#8212; 100 mg Ca \u2013 9 mg Ca<\/b><b>Elementar<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1098\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/Captura-de-Tela-2024-06-28-as-15.45.14-e1719600538877.png\" alt=\"\" width=\"723\" height=\"199\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/Captura-de-Tela-2024-06-28-as-15.45.14-e1719600538877.png 556w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/Captura-de-Tela-2024-06-28-as-15.45.14-e1719600538877-300x83.png 300w\" sizes=\"(max-width: 723px) 100vw, 723px\" \/><\/p>\n<p><b>2.5 Oligoelementos<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Apresenta\u00e7\u00f5es dispon\u00edveis:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">solu\u00e7\u00e3o com 04 oligoelementos (zinco, cobre, cromo e mangan\u00eas), com concentra\u00e7\u00e3o recomendada para pacientes adolescentes e adultos;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">sol. com 04 oligoelementos (zinco, cobre, cromo e mangan\u00eas), com concentra\u00e7\u00e3o que permite a utiliza\u00e7\u00e3o para pacientes neonatais e pedi\u00e1tricos;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">sol. com 09 oligoelementos (zinco, cobre, cromo, mangan\u00eas, iodo, fl\u00faor, ferro, sel\u00eanio e molibd\u00eanio). Indicada para pacientes a partir de 15kg;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">sol. de sulfato de zinco 200 mcg\/ mL;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">sol. de \u00e1cido selenioso 60 mcg\/ mL.<\/span><\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1099\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a8-e1719600647449.png\" alt=\"\" width=\"547\" height=\"217\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1100\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a9-e1719600719135.png\" alt=\"\" width=\"394\" height=\"320\" \/><\/p>\n<h6><span style=\"font-weight: 400;\">Tabela 8. Composi\u00e7\u00e3o Addaven\u00ae\/ Fresenius<\/span><\/h6>\n<p><b>2.5.1 Dose Padr\u00e3o de Oligoelementos\/ c\u00e1lculo\u00a0<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">As solu\u00e7\u00f5es utilizadas nas doses sugeridas como padr\u00e3o, na NUTRIMED, s\u00e3o as solu\u00e7\u00f5es contendo 04 poliminerais: Zn, Cu, Cr, Mn.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Lembrar que o Cromo e o Mangan\u00eas s\u00e3o elementos tra\u00e7o e, ser\u00e3o carreados com a dose ofertada do complexo de oligoelementos.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Iniciar o c\u00e1lculo pelo cobre (Cu<\/span><span style=\"font-weight: 400;\">\u00b2*<\/span><span style=\"font-weight: 400;\">).<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Ex.: dose padr\u00e3o sugerida para RN pr\u00e9-termo: Zn: 400 \u00b5g\/ kg e Cu: 20 \u00b5g\/ kg<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">1.Calcular a dose total de cada elemento, multiplicando pelo Peso para c\u00e1lculo:<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Peso: 1 kg<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Zn: 400 x 1 = 400 \u00b5g<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Cu: 20 x 1 = 20 \u00b5g<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">2. Calcular a quantidade de mL do complexo de oligo, pela dose desejada de Cu.<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">1 mL sol. oligo Ped ___ 100<\/span> <span style=\"font-weight: 400;\">\u00b5g Cu<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">X mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ___ 20 \u00b5g Cu<\/span><\/p>\n<p style=\"padding-left: 120px;\"><b>X = 0,20 mL sol. oligo Ped<\/b><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">3. Com o volume de sol. oligo Ped, verificar quanto est\u00e1 sendo ofertado de Zn:<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">1 mL sol. oligo Ped ___ 500 \u00b5g Zn<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">0,20 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ___ x<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">X = <\/span><b>100 \u00b5g Zn na sol. oligo Ped<\/b><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">4. Verificar quanto falta ofertar de Zinco para atingir a dose recomendada:<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">400 \u00b5g Zn<\/span><span style=\"font-weight: 400;\">total<\/span><span style=\"font-weight: 400;\"> \u2013 100 \u00b5g Zn <\/span><span style=\"font-weight: 400;\">sol. oligo ped <\/span><span style=\"font-weight: 400;\">= 300 \u00b5g Zn faltam<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">5. Ofertar a dose que falta sob a forma de Sulf. Zn:<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">1 mL S. Zn ____ 200 \u00b5g Zn<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">X \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ____ 300 \u00b5g<\/span><\/p>\n<p style=\"padding-left: 120px;\"><b>X = 1,5 mL S. Zn<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Para ofertar 400 \u00b5g\/ kg Zn e 20 \u00b5g\/ kg Cu, para o paciente com 1 kg, manipularemos:\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>0,20 mL de sol. oligo Ped + 1,5 mL S. Zn<\/b><\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Para calcular as doses de Cr e Mn carreadas:<\/span><\/li>\n<\/ul>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">1 mL sol. oligo Ped ____ 1 \u00b5g Cr \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 1 mL sol. oligo Ped ____ 10 \u00b5g Mn<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">0,20 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ____ x\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 0,20 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ____ y\u00a0<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">X = 0,20 \u00b5g Cr \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 y = 2,0 \u00b5g Mn<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.6 Vitaminas<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1101\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a10-e1719601083425.png\" alt=\"\" width=\"706\" height=\"396\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">As vitaminas s\u00e3o fornecidas atrav\u00e9s de complexos polivitam\u00ednicos.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Na NUTRIMED, a vitamina com registro no Minist\u00e9rio da Sa\u00fade utilizada, \u00e9\u00a0 o Cernevit\u00ae\/ Baxter.<\/span><\/p>\n<p style=\"padding-left: 40px;\"><b>Nota:<\/b><span style=\"font-weight: 400;\"> importante atentar que o Cernevit\u00ae n\u00e3o possui a vitamina K, devendo ser monitorada e suplementada a parte.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As doses padr\u00e3o sugeridas de vitaminas, baseiam-se nas recomenda\u00e7\u00f5es da ASPEN, que consideram faixa et\u00e1ria e peso.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">O c\u00e1lculo para convers\u00e3o em unidade de volume utiliza a Vitamina A como refer\u00eancia, ou seja, verifica-se a dose recomendada de vitamina A para o paciente (faixa et\u00e1ria e peso) e, calcula-se o volume de Cernevit\u00ae a ser administrado.<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\"><strong>Ex.:<\/strong> paciente rec\u00e9m-nascido, a termo, peso para c\u00e1lculo de 3,0Kg.<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Dose padr\u00e3o sugerida: 600 UI Vit. A<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">5 mL Cernevit\u00ae &#8212;- 3500 UI Vit. A<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0X \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 &#8212;- 600 UI Vit. A\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">X = (600 x 5)\/ 3500 = 0,857 = <\/span><b>0,86 mL de Cernevit\u00ae<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">As doses fornecidas das demais vitaminas podem ser calculadas atrav\u00e9s de regra de tr\u00eas, proporcional.<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Ex.: \u00a0 \u00a0 . Vit. D = 5 mL Cernevit\u00ae &#8212;- 220 UI Vit. D<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">0,86 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 &#8212;- x = 37,84 UI Vit. D<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">. Vit. E = 5 mL Cernevit\u00ae &#8212;-11,20 UI Vit. E<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">0,86 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 &#8212;- x =1,93 UI Vit. E<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">. Vit. C = 5 mL Cernevit\u00ae &#8212;-125 mg Vit. C<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">0,86 mL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 &#8212;- x =21,50\u00a0 mg Vit. C<\/span><\/p>\n<p style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">E assim, com todas as outras vitaminas da formula\u00e7\u00e3o.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.7 Volume NP\u00a0<\/b><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1102 \" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a12-e1719602978340.png\" alt=\"\" width=\"774\" height=\"102\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a12-e1719602978340.png 1024w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a12-e1719602978340-300x40.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a12-e1719602978340-768x101.png 768w\" sizes=\"(max-width: 774px) 100vw, 774px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">O volume total refere-se a taxa h\u00eddrica prescrita, o volume total que ser\u00e1 administrado no paciente. Nele estar\u00e3o contidos os volumes de todos os nutrientes prescritos e, se necess\u00e1rio, ser\u00e1 adicionado \u00e1gua (qsp) para chegar ao volume desejado.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Em Pediatria e Neonatologia, costuma-se utilizar a unidade <\/span><b>mL\/ kg<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.8 Volume de Equipo<\/b><\/p>\n<p><span style=\"font-weight: 400;\">O volume de equipo ou volume de excesso, \u00e9 o volume acrescido ao volume total prescrito na NP, que deve conter a mesma composi\u00e7\u00e3o.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">O objetivo \u00e9 o preenchimento do equipo de infus\u00e3o, garantindo que todos os nutrientes, com as doses prescritas pelo m\u00e9dico, sejam infundidos, sem perdas. Para isso, \u00e9 necess\u00e1rio calcular cada insumo, proporcionalmente.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">O equipo de infus\u00e3o ser\u00e1 descartado, ao t\u00e9rmino da administra\u00e7\u00e3o, contendo o volume de equipo.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">O volume de equipo dever\u00e1 ser verificado e informado \u00e0 NUTRIMED, pela unidade hospitalar, de acordo com o modelo\/ fabricante utilizado na bomba de infus\u00e3o para NP. Esta informa\u00e7\u00e3o ser\u00e1 inserida no Cadastro do Cliente e, as bolsas de NP, com solicita\u00e7\u00e3o de envio de volume de equipo, receber\u00e3o automaticamente o volume informado.<\/span><\/p>\n<p style=\"padding-left: 80px;\"><b>Nota:<\/b><span style=\"font-weight: 400;\"> importante manter o volume de equipo atualizado em caso de troca de equipo\/ bomba de infus\u00e3o.<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Ex.: Paciente, peso: 1 kg, taxa h\u00eddrica: 80 mL\/ kg, volume de equipo: 20 mL.<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Vol. Total: 80 x 1 = 80 mL\u00a0<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Vol. Equipo: 20 mL<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Vol. enviado ao cliente: 100 mL<\/span><\/p>\n<p style=\"padding-left: 80px;\"><strong>\u00a0<\/strong><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Aa 10%: 1,5 g\/ kg \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 1,5g = 1,5 x 10 = 15 mL Aa<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Glicose: TIG 4\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 (4 x 1 x 1440)\/ 1000 = 5,76g = 5,76 x 2 = 11,52 mL Glicose<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">EL 20%: 1,0 g\/ kg \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 1 x 1 = 1 g x 5 = 5 mL EL<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">AcNa: 1,0 mEq\/ kg\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a01 x 1 = 1 mEq\/ 2 = 0,5 mL AcNa<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">KCl: 1,0 mEq\/ kg\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 1 x 1 = 1 mEq\/ 1,34 = 0,75 mL KCl<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Glycophos: 1,0 mMol\/ kg\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a01 x 1 = 1,0 mMol = 1,0 mL = 2,0 mEq Na<\/span><span style=\"font-weight: 400;\">+<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">Gl. Ca: 300 mg\/ kg\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0300 x 1 = 300 mg = 300\/ 100 = 3,0 mL Gl. Ca <\/span><\/p>\n<p style=\"padding-left: 80px;\">S.Mg: 0,80 mEq\/ kg \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 0,80 x 1 = 0,80 mEq = 0,80\/ 0,81 = 0,99 mL S. Mg<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><b>C\u00e1lculo volume de equipo, calcular o FATOR:<\/b><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">80 mL\u00a0 \u00a0 ___ 15 mL Aa<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">100 mL ___ x\u00a0<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">X = <\/span><span style=\"font-weight: 400;\">100<\/span><span style=\"font-weight: 400;\"> x qtdd insumo = 1,25 x qtdd insumo<\/span><\/p>\n<p style=\"padding-left: 80px;\"><span style=\"font-weight: 400;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a080\u00a0\u00a0\u00a0<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"color: #3366ff;\"><b>Fator = 1,25<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Multiplicar cada volume do insumo pelo fator:<\/span><\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">Aa: 15 mL x 1,25 = 18,75 mL Aa<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">Glic: 11,52 mL x 1,25 = 14,40 mL Glic<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">EL: 5 mL x 1,25 = 6,25 mL EL<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">AcNa: 0,5 x 1,25 = 0,63 mL AcNa<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">KCl: 0,75 x 1,25 =\u00a0 0,94 mL KCl<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">Gly: 1,0 x 1,25 = 1,25 mL Gly<\/span><\/p>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">Gl. Ca: 3 x 1,25 = 3,75 mL Gl. Ca<\/span><\/p>\n<p style=\"padding-left: 40px;\">S.Mg: 0,99 x 1,25 = 1,24 mL S. Mg<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Somar os volumes calculados: 18,75 + 14,40 + 6,25 + 0,63 + 0,94 + 1,25 + 3,75 + 1,24 =\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><span style=\"font-weight: 400;\">47,21 mL<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">O volume final com equipo = 100 mL, portanto, qsp com H<\/span><span style=\"font-weight: 400;\">2<\/span><span style=\"font-weight: 400;\">O = 52,79 mL<\/span><\/li>\n<\/ul>\n<p><b>Importante:<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">No r\u00f3tulo, as quantidades descritas s\u00e3o as doses da prescri\u00e7\u00e3o m\u00e9dica (o que ser\u00e1 infundido).<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>2.9 F\u00f3rmulas Sugeridas (FS)<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-1105 size-full\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a14-e1719604148607.png\" alt=\"\" width=\"883\" height=\"391\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a14-e1719604148607.png 883w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a14-e1719604148607-300x133.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/06\/a14-e1719604148607-768x340.png 768w\" sizes=\"(max-width: 883px) 100vw, 883px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">As F\u00f3rmulas Sugeridas (FSs) foram desenvolvidas para servir como modelos de prescri\u00e7\u00f5es de NP, para pacientes Adolescentes (FS7) e adultos (8 a 12), de acordo com o metabolismo (FS8 a 10), aus\u00eancia de emuls\u00e3o lip\u00eddica (FS11) e, utilizando a solu\u00e7\u00e3o de amino\u00e1cidos para pacientes com hepatopatia (FS12).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Para prescrev\u00ea-las, basta selecionar a FS desejada e, o volume total. Os insumos ser\u00e3o calculados de forma proporcional ao volume solicitado.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>2.10 Osmolaridade<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Par\u00e2metro que avalia a via de infus\u00e3o recomend\u00e1vel \u00e0 administra\u00e7\u00e3o da NP.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">O limite recomendado para a via de acesso perif\u00e9rico \u00e9 de at\u00e9 900 mOsm\/ L, acima deste valor, recomenda-se a via de acesso central a fim de prevenir o surgimento de flebites.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><strong><span style=\"color: #000080;\">mOsm\/ L<\/span><\/strong><span style=\"color: #000080;\">=<\/span><span style=\"color: #000080;\"> {(g Aas x11) + (g glicose x 5,5)+ (g lip\u00eddio x 0,3) + (\u2211mEq de c\u00e1tions)} x1000<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-weight: 400;\"><span style=\"color: #000080;\">volume final da NP em mL \u00a0<\/span> \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\n<h6 style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">Adaptado de: Gastaldi, M; Siqueli, AG; Silva, ACR; Silveira, DS. Farm\u00e1cia Hospitalar. Nutri\u00e7\u00e3o Parenteral: da Produ\u00e7\u00e3o a Administra\u00e7\u00e3o. Pharmacia Brasileira, setembro\/ outubro, 2009.<\/span><span style=\"font-weight: 400;\">8<\/span><\/h6>\n<h6 style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">. Aas: quantidade de amino\u00e1cidos, expresso em gramas (g)<\/span><\/h6>\n<h6 style=\"padding-left: 120px;\"><span style=\"font-weight: 400;\">. \u2211C\u00e1tions: somat\u00f3rio em mEq de c\u00e1lcio, magn\u00e9sio, s\u00f3dio e pot\u00e1ssio<\/span><\/h6>\n<p>&nbsp;<\/p>\n<h6><b>Refer\u00eancias<\/b><\/h6>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Mirtallo et al. Safety Practices for Parenteral Nutrition. ASPEN Special Report. Journal of Parenteral and Enteral Nutrition. 2004, Vol. 28, n<\/span><span style=\"font-weight: 400;\">o<\/span><span style=\"font-weight: 400;\">6. S39-S70.<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Diretriz BRASPEN de Enfermagem em Terapia Nutricional Oral, Enteral e Parenteral. BRASPEN J 2021; 36 (S3): 2-62.<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Appropriate Dosing for Parenteral Nutrition: ASPEN Recommendations. ASPEN, 11\/ 07\/ 2020. In: nutritioncare.org\/PNresources.<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Pocket book Fresenius. Sempre presente na Nutri\u00e7\u00e3o Parenteral, 2024.\u00a0<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Bula profissional Primene\u00ae\/ Baxter. In: https:\/\/emeaclinicalnutrition.baxter.com\/primene<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Carnielli VP, Correani A, Giretti I, D Apos Ascenzo R, Bellagamba MP, Burattini I, et al. Practice of Parenteral Nutrition in Preterm Infants. World Rev Nutr Diet. 021;122:198-211.<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Guia Pr\u00e1tico de Atualiza\u00e7\u00e3o da Sociedade Brasileira de Pediatria. Recomenda\u00e7\u00f5es para Nutri\u00e7\u00e3o Parenteral em Rec\u00e9m-nascidos Pr\u00e9-termo: Consenso dos Departamentos Cient\u00edficos de Suporte Nutricional e Neonatologia.<\/span> <span style=\"font-weight: 400;\">SBP,<\/span> <span style=\"font-weight: 400;\">N\u00ba 108, 09 de Outubro de 2023.<\/span><\/h6>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h6><span style=\"font-weight: 400;\">Gastaldi, M; Siqueli, AG; Silva, ACR; Silveira, DS. Farm\u00e1cia Hospitalar. Nutri\u00e7\u00e3o Parenteral: da Produ\u00e7\u00e3o a Administra\u00e7\u00e3o. Pharmacia Brasileira, setembro\/ outubro, 2009.<\/span><\/h6>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; COMPOSI\u00c7\u00c3O DA NP A NP pode ser composta por macronutrientes (amino\u00e1cidos &#8211; Aas, glicose e emuls\u00e3o lip\u00eddica &#8211; EL) e micronutrientes (vitaminas, oligoelementos e eletr\u00f3litos). Cada nutriente \u00e9 prescrito de acordo com as necessidades nutricionais individuais.\u00a0 De acordo com [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1117,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts\/1087"}],"collection":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=1087"}],"version-history":[{"count":0,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts\/1087\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/media\/1117"}],"wp:attachment":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=1087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/categories?post=1087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/tags?post=1087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}