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6 year-old male well-nourished patient receives IV fluids nightly with D10 ½ normal saline 1000 ml over 12 hours. Mother pages on-call provider concerned that Broviac might have come out 3 cm. Patient is asymptomatic. Next visit is scheduled for 1 week. What is the next step? A. Reassurance and...

Question 10. 5 year-old male with long-term HPN dependence secondary to short bowel syndrome is seen for routine follow-up. Enteral tolerance is currently maximized. PN currently providing energy 45 kcal/kg/day, protein 1.3 gram/kg/day, IV soybean lipids 1 gram/kg/day, glucose infusion rate 10 mg/kg...

Chronic intestinal pseudo-obstruction Definition: Heterogenous group of disorders characterized by disordered peristalsis leading to intestinal malabsorption and pseudo-obstructive crisis. Some types are acute. Radiograph showing marked small bowel dilatation without evidence of an abrupt transition...

Energy, Fluid, Acid-Base & Electrolyte Management Dextrose Amino Acids Lipids Micronutrient monitoring & disorders Iron deficiency anemia (including intravenous iron)

Patient is 13 year-old female unable to tolerate any enteral intake due to chronic small bowel obstruction and a history of heavy menses. For past 6 months, she complains of worsening fatigue and pallor. Hemaglobin is 8 (low), MCV 66 (low and previously normal). On exam, there is no tachycardia...

2 year-old male had a recent adjustment in parenteral nutrition infusion cycle from 18 to 12 hours. There was no change in PN concentration. As a result, the glucose of infusion rate changed from 14 to 25 mg/kg/minute. Mother calls to complain that has symptoms of polydipsia and dehydration during...

The parent of an 8 year-old female with chronic parenteral nutrition dependence secondary to chronic intestinal pseudo-obstruction calls with leaking at right upper extremity peripherally inserted central catheter (PICC) within 2 hours of nightly infusion. What is the first thing to recommend to...

5 year-old female with HPN dependence secondary to meconium pseudo-cyst develops acute agitation, headaches and vomiting immediately upon infusing HPN, which is a new batch from that was delivered yesterday. Of note, there have been no recent HPN prescription changes. Patient lives with parents in a...

Patient is a 16 year-old male chronic parenteral nutrition dependence secondary to short bowel syndrome secondary to atresia. Despite several intestinal lengthening procedures at your center, he continues to receive the vast majority of his nutrition intravenously. Family complains that frequent in...

Family notices there is something unusual about the appearance of their child’s central line (see photo below). The line is functioning fine. There is no leaking. The patient is asymptomatic. What is the problem? A. Outer lumen fracture B. Inner lumen fracture C. Central line thrombus D. Central...