Dextrose content is gradually increased over the next few days to the estimated daily energy requirement as the patient adapts to the increasing amounts of dextrose. Typically, a hospitalized patient may lose 12 to 18 g of nitrogen a day, and in severe trauma the daily loss may be 20 to 25 g or more. Aminosyn II solutions without electrolytes are intended for patients requiring individualized electrolyte therapy. Serum electrolytes should be monitored as indicated. Electrolytes may be added to the nutrient solution as indicated by the patient's clinical condition and laboratory determinations of plasma values.
Major electrolytes are sodium, chloride, potassium, phosphate, magnesium and calcium.
Vitamins, including folic acid and vitamin K are required additives. The trace element supplements should be given when long-term TPN is undertaken. Solutions which contain potassium ion should be used with great care, if at all, in patients with hyperkalemia, severe renal failure and in conditions in which potassium retention is present. Calcium and phosphorus are added to the solution as indicated. This requirement is related to the energy delivered by carbohydrate.