Quote from EricTAMUCC-BSN
The reason I ask is because I have a s/p rue en y gastric bypass patient who weighs over 400 lbs and we are trying to make sure we don't shoot ourself in the foot.
The number of calories depends on the concentration of dextrose/additives/lipids. And these vary greatly from person to person and also varies day to day, as most TPN is tailored to the specific needs of the patient and generally based on the daily labs, I/O, weight and condition - in most facilities. The dietician, MD and PharmD all have input in what the best formulation is for the patient. Therefore, they should be the ones to make the decision on "withholding" lipids, etc.
As a matter of note, some MDs use lipids to help protect venous integrity, more so than for their calorie value. In addition, to just withhold lipids alters the balance of nutrients going into the bloodstream and could seriously destabilize the patient. All "withholding" of TPN/lipids should be decided by the MD/PharmD, with input from the dietician.
The TPN also frequently contains vital vitamins, electrolytes, and medications to maintain a certain balance in the patient.
While we generally want the gastric bypass patient to lose weight, it needs to be in a controlled manner, to prevent serious health consequences. Too rapid weight loss can cause serious health issues of itself. And while the patient may be worried about getting "sugar" water and "fats", adequate balanced nutrition is essential to proper recovery from surgery and good health.