Answer 10. The correct answer is c. Increase glucose infusion rate by 2 mg/kg/minute to increase calories by 10%. Nutrition should be advanced by enteral route whenever possible. However, PN support should be increased when growth is faltering as evinced by 2-3 consecutive visits with inadequate weight or height gain or weight loss. If soybean based IV lipid emulsions are used, the dose should be restricted to at most 1 gram/kg/day in patients on long-term PN. Protein should be used for lean mass accrual, not caloric support per se. A number of micronutrients could be considered to explain inadequate growth velocity in this patient, such as zinc, copper, sodium and others. Levels may be checked, and providers should ensure that there’s adequate dietary provision. Inflammation may interact with growth and protein catabolism through a variety of mechanisms, including tumor necrosis factor alpha.
