\documentclass[10pt,a4paper]{article}

% Packages
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\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
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%\usepackage[utf8x]{inputenc}    % For unicode character support
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\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Michellephillips02}
\pdfinfo{
  /Title (pn.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (PN Cheat Sheet)
}

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% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
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% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PN Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46717/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th July, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Indications}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Gut not functional/accessible = complete bowl rest}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cannot meet needs orally}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{PN duration longer than 5 days}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{E.g. {\emph{bowel obstruction, gut ischemia, ileus/GI stasis, fistula, radiation damage, intractable vomiting, persistent severe diarrhoea, short-bowl, Crohn's, trauma, critically ill, malnourished, SBS, burns}}} \tn 
% Row Count 9 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Routes}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Central - TPN}} & Into superior vena cava, hypertonic solution. Larger vein. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Peripheral line – PPN}} & \textasciitilde{}Short-term. Into arm//legs/hands. Lower osmolarity. Only when central line is not available. \tn 
% Row Count 7 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.23965 cm} x{2.73735 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Formulas}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{NO micronuts \& trace elements}} - Come in separate vials (Soluvit, Vitalipid, Cernevit) – added to bag when administered or an injection} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\emph{SCHU: Administered with 100mL saline over 24 hours.}}} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{CHO}} (as dextrose) & max total: 2g/kg. Max rate: 4-5mg/min/kg \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} (as free AA \& electrolytes) & {\bf{1g N = 6.25g protein.}} N usually in name - "SuperPH 24" = 24 g N. \tn 
% Row Count 11 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & Standard solutions = 1.0-1.2g/kg. Standard bag (3-in-1): 10-15\%. Standard bag (2-in-1): 15-25\%. \tn 
% Row Count 16 (+ 5)
% Row 5
\SetRowColor{white}
{\bf{F}} (as lipid emulsion) & Minimum 0.5 mg LCT/kg/d to prevent EFA deficiency. Standard bag (3-in-1): 30-45\%, Standard bag (2-in-1): 0\%. \tn 
% Row Count 21 (+ 5)
% Row 6
\SetRowColor{LightBackground}
{\bf{Energy}} & 0.6-1.2 kcal/mL \tn 
% Row Count 22 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.84149 cm} x{3.13551 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Regimes}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Continuous}} & 40-150 ml/hour for 24 hours. Don't need to start lower rate (unless risk of refeeding or if hyperglycaemic). Refeeding = 50\% of reqs, ↑ when biochem stable. \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
 & {\emph{SCUH policy: start rate = $\frac{1}{2}$ goal for the first 12 hours.}} \tn 
% Row Count 10 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Intermittent/cyclic}} & 100-300ml/hour. Eg. only at night or on specific days of the week \tn 
% Row Count 13 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Dual Feeding}} & PN \& EN – helps maintain gut function – gut integrity \& gut microbiome \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{DA Parenteral feeding manual and guidelines} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{ASPEN refeeding consensus recommendations (2020)} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ESPEN guideline on home parenteral nutrition} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Reqs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Simple ratio – same as EN} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Consider any fluid restrictions – {\bf{NO FLUSHING IN PN}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{All additional fluids = IV} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Bag volume = fluid (not like EN)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{GI Losses: ↑ reqs zinc, copper \& selenium} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Long-term PN}}: Gradual depletion of stores: trace elements \& fat-sol vits. Greater risk of micronutrient deficiencies} \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Transitional feeding – PN to EN}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Step 1}}: Start EN 30-40mL to establish GI tolerance.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Step 2:}} PN rate can be slowly reduced to keep nutrient levels at the same prescribed amount} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Step 3:}} Continue increasing EN rate and decreasing PN rate until full requirements are met by EN} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Transitional feeding – PN to oral}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pts w/ unstable BG or ↓ glycogen:}} Taper infusion to 50\% for an hour, review insulin dosage \& cease insulin infusion, OR replace PN with 10\% dextrose at same rate as PN for an hour} \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Concerns: ↓ gut microbiome biodiversity, ↑ inflammation} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Strategies to ↑ oral intake – ONS/EN/oral intake} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Biochem – refeeding, hypo/hyperglycaemic} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{If reqs aren't met (due to fluid restrictions): consult w/ med team. Reduce IV?} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Weight = daily-weekly} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Fluid balance = hourly. Totalled daily} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{BGL: every 6 hours-daily} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Troubleshooting}}  \tn
% Row 0
\SetRowColor{LightBackground}
Nausea or vomiting & anti-nausea meds, swap to cyclic, reduce rate \& run continuously, 2-in-1 instead (no fat) \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
Too hungry & Swap to cyclic \& ↑ rate. \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Too full & slow rate \& run continuous. \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\seqsplit{Constipation} & Medication. Ensure adequate fluid. \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Overfeeding & ↑ BGL, serum triglycerides, AST \& ALT. Glucose: higher than 5mg/min/kg is unlikely to be tolerate. \tn 
% Row Count 12 (+ 4)
% Row 5
\SetRowColor{white}
\seqsplit{Hyperglycaemia} & Swap to a higher lipid, lower glucose formula \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Dehydration & supplemented with IV fluids. ↑ rate ≠ ↑ hydration \tn 
% Row Count 17 (+ 3)
% Row 7
\SetRowColor{white}
Fluid overload & Consider other fluid sources – IV, medications, line flushing. Change to a more concentrated formula. \tn 
% Row Count 21 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}