MINERALS and VITAMINS in NEONATAL TPN- Part 3 - Tala Talks NICU

[@TalaTalksNICU]

ERROR in video!! Thanks so much to the brilliant Mel Wall for pointing this out! Not sure how it got through us. At 7 mins 38 seconds: we were calculating how much Na is given to a 500g infant if the UAC runs at 1ml/hr of 1/2NS. We calculated it as if the infant was getting NS- so in actual fact, should be 77meq Na in 1L. Final answer is 3.69meq/kg/day. SORRY EVERYONE!!!

[@hafsaomer7022]

Thank you so much for creating this educational material. This is my first week as a neonatology clinical fellow. I finished the fluid series in one shot. I would highly recommend your channel to all residents and beyond, and I wish I knew this wonderful channel earlier. Thank you for the effort you are putting to make the branch of neonatology easy. HMC, Doha, Qatar.

[@TalaTalksNICU]

Hello Dr. Osmer- thank you so much for taking the time to write to us in your busy schedule- and for encouraging others to watch the channel. We really appreciate it! Hope your fellowship goes smoothly. And hope you get to see some of the World Cup live!!!

[@sabajunaid8174]

Thank you very much Dr Tala. These videos are incredible. You made TPN so much clearer for. I am working in UK in neonates your lectures are very useful.

[@TalaTalksNICU]

Oh YAY! That makes us so happy you find the videos useful! Thank you so much for letting us know :)

[@VernalAffluence71]

Kindly make a video lecture on neonatal cholestasis in detail.

[@TalaTalksNICU]

Yes! This is a great idea for a video- thank you so much!

[@osamaalagamawy3891]

ما شاء اللة. بارك اللة فيكى. أعتقد حضرتك تستحقى جائزة نوبل فى التعليم الطبى......فلدى حضرتك موهبة ربانية.

[@TalaTalksNICU]

My father translated this for us :) May be the nicest comment I've ever received- Nobel prize! Thank you so much Osama :)

[@dave4468]

Watched the whole series, excellent info and presentation! Love how you also show your references. Would you be able to do a video on writing a TPN for an example patient and go over your thought process? Would be interested to see how you apply these concepts in your every day practice

[@TalaTalksNICU]

Thanks SO much!!! I LOVE this idea! Will figure out how to do it- without getting in a patient’s chart!!! But you’re right- this is way more relevant- how to put all into practice!

[@beatrixross6584]

Don't mean to be a finicky, but perhaps someone might understand it better if I point this out. Tala, you had me puzzled with the volume concentration calculation most of the afternoon, I just couldn't get it figured out 😮. Until I realised that the 4.16 (1000ml/24ml) is a factor/ratio and don't have a unit (in the video it states 4.16meq). So the 4.16 is the ratio 1000ml needs to reduce to 24ml and that the concentration of the Na should decrease with the same ratio. Thank you so much for the tremendous effort and prep you put into your videos! - Beatrix from Welkom, Free State, South Africa ❤

[@TalaTalksNICU]

Oh Beatrix I’m sorry!!!!! How confusing- the only slight positive I’m gonna take from this is that you now understand this better than ever. Sorry about the mistake and thank you for pointing it out! Obviously I didn’t edit this thoroughly enough because there was another mistake caught too- so please get everyone you know-to like your comment so that it’s high up in comments since I can only pin one!!!!! Thank you thank you for taking time to write to us- I feel bad people have been learning this wrongly for some time :(

[@naitramsingh6942]

Amazing video as always, thanks to you and your team for always making complicated topics simpler, thanks and do tc

[@TalaTalksNICU]

Thank you so much- as always :) It was a little dry- but we needed to get it out there for completion!!! Thanks again :)

[@abohoor1368]

good work

[@TalaTalksNICU]

Thank you so much :)

[@laraeb2514]

Another fantastic video! 👏

[@TalaTalksNICU]

Thanks so much Larae! This one was really dry- but we had to get it out there!!!

[@adrianafinot7631]

PPHN crisis / Cardiac Arrest please ! And meds love your videos super helpful ❤️🙏🏽

[@TalaTalksNICU]

Thank you so much!! have you seen PPHN video? Maybe that will help a little? Although the superimposed crisis is a good idea- and we definitely need to get around to codes! Thank you for watching :)

[@KendallBergmann]

Thank-you! Could you do a talk on TORCH infections?

[@TalaTalksNICU]

YES!!! We need to do this ASAP!!! Thanks for being here!

[@felipeguinancio7456]

Another great video Dr Tala! Thank you so much! I know its a complex theme but If possible would enjoy to know your experience about IMDs at the Nicu. When do we start to think about it? Thank you so much again. Keep up The good work.

[@TalaTalksNICU]

Hello! You're right- so complex! But we are planning a simple video on exactly what you suggested- when to think about inborn errors of metabolism, and generally what labs etc to send. We mentioned it briefly in one of the 10K videos (I think the first one?) if you want to watch that until we get the video out!

[@felipeguinancio7456]

Thank you! I will look forward to it.

[@melwall6855]

Love all your videos, especially for NNP boards studying. I do have a question regarding this particular TPN calc video: your example with the 500g infant getting 1ml/hr if 1/2NS through the UAC. Do you not have to use 77 meq of sodium in 1L for your calc vs the usual 154meq since your said this is 1/2NS and not 0.9NS? Would love a video with some more calculations with examples because they definitely ask these questions on boards and very few study materials actually provide any good examples! Thank you! Messaging you from USA

[@TalaTalksNICU]

Hello Mel! Thanks SO much for catching that mistake! A big one!!! It was my fault- I couldn't decide whether to give an example of a NS bolus or of UAC running and I ended up mixing the two. I'm so sorry- but so grateful to you for pointing it out. Also- you sent the message in such a sweet, inoffensive way- which is how we should all work together in the NICU- you're gonna rock this position! Thank you! What sort of equations do you need to know for your boards? Would love to do a video on this! Or is there a curriculum somewhere I could look through?! Thanks again so much Mel for taking the time to write to us :)

[@dave4468]

What if the recommended sodium (2-3mEq/kg/day), but that ends up giving you a hypotonic TPN? Wouldn't you be concerned that this could cause hyponatremia? I don't understand the idea of calculating sodium "additively" with mEq/kg/day, wouldn't it be better to base it off concentration since the concentration of the solution compared with the body fluid is going to be what ultimately causes a shift in sodium? i.e. Assuming stable patient, why wouldn't we make a TPN going through central line closer to 150mEq/liter and isotonic instead of doing these calculations and ending up with a hypotonic solution? This could potentially result in situations where the sodium is "10meq/kg/day", but the solution itself would be isotonic. Hope my question makes sense

[@TalaTalksNICU]

Great question! Remember sodium isn’t only substance in TPN- there is also dextrose and other electrolytes- so if we have normal saline- it will be hypertonic. But also- the steady state we end up with in TPN is dependent on so many factors- insensible losses, kidney losses, GI losses- all of it!!! So really/ it does end up being a lot of trial and error- checking labs and making changes. Sometimes I’ve had to out babies on 10meq/kg/day for short periods because their kidneys weren’t working well or they had some transient adrenal insufficiency or whatever. Hope this answer helps?!!

[@m.e.2286]

Thank you for your helpful videos. Would you please make a series about BPD? 🙏🏼☺️

[@TalaTalksNICU]

YES! Next one coming out- whether in a week or two. It's filmed and edited. Will be in two videos. Thanks so much for watching :)

[@m.e.2286]

@@TalaTalksNICU oh wow you are amazing! 🥰

[@TalaTalksNICU]

That was all Arianna :)

[@m.e.2286]

@@TalaTalksNICU awesome teamwork!

[@mohamedbadawi7739]

perfect

[@TalaTalksNICU]

Thank you so much for all your lovely comments :)

[@osamaalagamawy3891]

❤❤❤

[@TalaTalksNICU]

Thanks so much for being here :)

[@raibinodini3625]

Please reply.... How to check Baby brain development? (6 to 12 months)

[@TalaTalksNICU]

Hello- the only very accurate way to check brain development is by following the chid's neurological functioning. MRIs and CT scans can give rough ideas of what's going on with the brain- but even based on these pictures we are not great at giving prognosis. Good luck!