Ped Quiz.
m_k_s | Jan 05, 2010 | 3 comments
[1] A 6 month old infant has large, foul smelling stool and is not gaining weight. Sweat chloride level was 68 mmol/L. Appropriate nutritional recommendation include which of the following and why?
- change to elemental formula.
- pancreatic enzyme replacement.
- high-fat diet.
- low protein diet.
- low carbohydrate diet.
[2] A 7 month old infant receives chronic TPN for short gut syndrome. On discharge, you discuss with the parents about the possible complications of this mode of nutrition. Which of the following is the typical complication of TPN and why?
- sepsis.
- renal failure.
- chronic diarrhea.
- vitamin A deficiency.
- irreversible atrophy of the mucosa of the small intestine.
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Filed Under: Discussion • pediatrics
Thank you M_K_S for your question
I think,
the correct answer for the 1st one is pancreatic enzyme replacement because the baby is suffering form cystic fibrosis.
and the answer for 2nd one is ,a sepsis because TPN is given through center vein.
Your 1st answer is correct. The main aim of the treatment is to supply enough calories to maintain normal growth. The patient will experience poor digestion of fat and protein as a result of the deficiency of pancreatic function. The pancreatic enzyme replacement will correct those deficiencies.
Yes, you are absolutely right. Sepsis is the typical complication. The usual pathogen isolated is CONS. Small intestinal mucosal atrophy is reversed with oral feedings. Concerning Diarrhea: children with short gut syndrome tend to have chronic diarrhea but TPN is not the direct cause. I would like to add more about the complications: thrombosis, extravasation, cholestatic jaundice (about 1/3 develop jaundice after 2 wks of TPN), hypoglycemia, hyperglycemia, overfeeding, hyperlipidemia and osteopenia.
thank you m_k_s