SGI

Last week was generally not as eventful as the beginning of the week, hence why I didn't write much. 

This week is GI surgery, which actually encompasses a lot of transplants, bariatric surgery, pancreas issues, and overall GI surgery. There is a separate position for GI medical, so I won't be seeing many issues with irritable bowel, Chron's, or other conditions like those.

Today I didn't see too many crazy patients, mostly just a good introduction. I saw a patient who was post-hysterectomy, and just had to make sure she was tolerating her diet after her surgery and making sure she has adequate protein intake. I also saw a patient who had just had a kidney transplant and...

*drumroll...

I got to practice my first TPN! I was excited to actually practice recommending a specific TPN order on an actual patient. It was good practice and I tried it a new way, which actually made it a lot easier to do. For example...

Estimated kcal needs: 2300 kcal

Estimated protein needs: 100g

If a patient gets two infusions of lipids at 500ml 20% lipids twice per week, that's 2000 kcal (each ml of lipid is 2 kcal). Divide this by 7 days per week, which is an average of 286 kcal per day.

2300-286 = 2014

And, we'd like about 100g protein (in the form of amino acids).

100g x 4kcal/g = 400 kcal

2014 - 400 = 1614 kcal

And, since all we have left is dextrose, we divide 1614 by 3.4 (how many kcal are in one gram of dextrose), and we get 475 g of dextrose! 

So, just to check our math...

475 x 3.4 = 1615

100 x 4 = 400

286 kcal from fat 

Total = 2251

Which, is pretty darn close to 2300 kcal per day! Then, of course, it's important to factor in electrolytes, but that's another different story.

Anywho, that's about the extent of my day today. Apparently there's a winter storm that's "history in the making!" So I'll be staying in Ann Arbor tomorrow night with other interns, just in case :)