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Celeste O’Mealy

NUTR 407-MNT I lab

Breanda O’Day

10 October 2019

Practice PN Calculations-Homework Assignment

1. You are consulted to make recs for TPN for a 55 y.o. female (45
kgs). The current formula is 400mL 10% AA, 100mL 70%
dextrose, 200mL 20% lipid.

Estimated needs:
20-25 kcals/Kg = 900 –1125 kcal
1.2-1.5 gms protein/kg = 54 – 68 gms
25-30 mL/kg = 1125 – 1350 ml

Calculate the current formula provision of:

 Gms of dextrose, kcals provided and mg/kg/min


o 100 ml x .70=70 gm
o 70 gm x 3.4 kcal = 238 kcal
o 70 gm / 45 kg / 1.44= 1 gm/kg/min

 Gms of protein, kcals and gm/kg


o 400 ml x .10= 40 gm
o 40 gm x 4 kcal = 160 kcal
o 40 gm/45 kg = 0.89 gm/kg

 Lipid
o 200 ml x .2= 40 gm
o 40 gm x 10 kcal = 400 kcal

 Total Kcals of the TPN =798 kcal / 45 kg= 15 kcal/kg


 % AA’s = 160 kcal / 798 kcal= 20%

 % lipids = 400 kcal / 798 kcal = 50%

 % dextrose = 238 kcal /798 kcal = 30%

 NPC:N2 ratio = 100:1


o 40 gm/ 6.25 = 6.4 g N2
o 638 kcal / 6.4 = 100:1

Protein provision: 40 gm pro / 45 = 0.89 gm/kg

What would you do different to better meet this patients’ estimated


needs? Hint: Show your new provision.
I’m going to increase protein to 1.2 gm/kg =216 kcal and I’m
going to increase dextrose to 1.3gm/kg/min= 289 kcal, to better meet
pt kcal needs. The fluids provided only supply 721 ml/d and I would
provide an additional 404-629 ml/d to meet pt needs through periodic
fluid flushes of 200 ml two to three times per day.

New provision:
Gms of dextrose, kcals provided and mg/kg/min
o 121 ml x .70=85 gm
o 85 gm x 3.4 kcal = 289 kcal
o 85 gm / 45 kg / 1.44= 1.3 gm/kg/min

 Gms of protein, kcals and gm/kg


o 400 ml x .10= 40 gm
o 40 gm x 4 kcal = 160 kcal
o 54 gm pro / 45 kg = 1.2 gm/kg

Total Kcals of the TPN =905 kcal / 45 kg= 20 kcal/kg

 % AA’s = 216 kcal / 905 kcal= 24%

 % lipids = 400 kcal / 905 kcal = 44%


 % dextrose = 289 kcal / 905 kcal = 32%

 NPC:N2 ratio = 100:1


o 54 gm/ 6.25 = 8.6 g N2
o 689 kcal / 6.4 = 80:1

2. A 45 y.o. male (75 kgs) adm with an extensive resection for


colon CA. A PICC line is in place. What are your
recommendations for parenteral support?

Estimated needs:
23-25 kcals/Kg = 1725-1875 kcal/d
1.3-1.5 gms protein/kg = 98-113 gm/d
25-30 mL/kg = 1875-2250 ml/d

Show calculations of your formula:

 Gms of dextrose, kcals provided and mg/kg/min


215 ml x .70=151 gm
151 gm x 3.4=513 kcal
151gm/75kg/1.44=1.4 gm/kg/min

 Gms of protein, kcals and gm/kg

o 1000 ml x .10= 100 gm


o 100 gm x 4 kcal = 400 kcal
o 100 gm/75 kg = 1.1 gm/kg

 Lipids:
o 475 ml x .20= 95 gm
o 95 gm x 10 kcal = 950 kcal

 Total Kcals of the TPN = 1863 kcal = 25 kcal/kg


 % AA’s = 22%

 % lipids =51%

 % dextrose = 28%

 NPC:N2 ratio = 91:1


o 100 gm / 6.25= 16 gm N2
o 1463 kcal /16 gm N2= 91:1

Recommendation in grams and volume:


● Recommendation for protein: 100gm of protein/.10 = 1 L solution
● Recommendation for CHO: 151 gm of CHO/ .70 = 215 mL solution
● Recommendation for Lipid: 95 gm of lipid/ .20 = 475 ml solution
● Recommendation for fluid: 185-560 ml additional solution in the
form of fluid flushes of 200 ml one to three times per day.
• 1875 ml - 1690 ml= 185 ml
• 2250 ml – 1690 ml=560 ml