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EASY WAY TO CALCULATE TPNPRADEEP SINGH MDCal est needsHarris benFor BEE: M=66.47+13.75(WT IN KG)+5(HTINCM)-6.76(AGE YRS)

F=655+9.6(WT KG)+1.7(HTCM)-4.7(AGEYRS)Activity factor from 1.0-1.2Stress factor 1.1-1.3 in non burn pt

Irenton-jonesOn Vent 1784-11(age)+5(wt kg)+244 for Males +239 for trauma

+0 for Female+0 if no trauma

STEP1FIRST CALCULATE NUTRITIONAL NEEDS PER DAY1A ~ PROTEIN/24 HOURS(NEED 1.5 TO 2 .0 GRAM )FOR EX. 75 KG MAN WILL NEED 75X1.5=105 GRAMand TOTAL CALORIE NEED IS IF 1750 TOTAL (YOUCAN CALCULATE BY HARRIS-BENEDICT)SO 105 X4=420 CALORIE FROM PROTEINNOW 1750-420=1330 NPC NEED

1B~ LIPID Kcal/24 h=400?(USUALLY 30-40%ON NON PROTEIN kCAL IFMEETING 100%OF CALORIE NEEDS OTHERWISE

COULD BE >30%) .SO 30%OF 1330CAL=400 .1C~ DEXTROSE Kcal/24HRS=930?REST 1330-400(from fat)=930 FROM CARBNOW CONVERT Kcal TO GRAM930Kcal/24 hrsDEVIDED BY 3.4=274 GRAM DEXTROSE(USUALLY 60%OF NON-PROTEIN Kcal IF MEETING 100%OF CALORIE NEEDS.)

STEP 2VOLUME CALCULATIONS2A~.WE HAVE 15%AMINO ACID SOL FOR COMPUTERIZED ADMX

SO 105 [1A]DEVIDED BY.15=700ML2B~WE HAVE 20%SOL FOR LIPIDS ADMIXTURE

SO 400 [1B]Kcal X.5(20%)=200 ML/D

2C~WE HAVE 70%DESTROSE SOL FOR ADMIXTURESO 274 [1C]DEVIDED BY .70=392ML2D~FINAL VOLUME 1300 ML/24HR[round to nearest 100ml]STEP3FINAL ORDERS AT HVMC FOR 3 IN 1 TPN3A~105 [1A]DEVIDE BY1300[2D]X100=8%AA

[round to nearest 0.5%]3c~274(1c)devided by 1300x100=21%dextrose.

[round to nearest0.5%]STEP 4 MICRONUTRIENTS1.OBTAIN BMP Mg Phos2. find pt wt in kg3.EST Require of Na &K 1-2 mEq/kg body wt unless pt is in renal failure

Phos req 15-40 mmol/day, Ca 9-22mEq/day, Mg 8-24 mEq/dayI do not prefer to use TPN II electrolyte pkg as it complicates.4.Go to Ca first. Needs usually 9.4 mEq/day

Mg :Except for renal failure,may start at 12-21 mEq. Start high endif risk for refeeding syndrome.Our sol has4mEq/l of strenthso remember that all numbers should be divisible by 4 mEq .

phos:Usual level 15 -21 mMol except for renal failure.number mustbe devisible by 3 (because our sol has Po4 3mM/ml strenth)

CHECK Ca Phos ratioPhos in mmolx1.8xCa in mEq must be

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conversion factor Eg. 18 mmolof Phos=conver fact of 6Na Phos has 4mEq Na or conv factor( 6)x4 mEq =24 mEq NaKPhos has 4.4 mEq K or con factor(6)x4.4mEq=26.4 mEq K

5. Balance Na K and Cl Acetate.Acetate =(gm of Protein devided by 150 x108 for 15%sol ofAmino acid [108 is known facor for % of AA sol]

SODIUM POTA CHLORIDE ACETATE28 NaPhos 50 KCl 50 (KCl) 76 (in TPN)44 NaCl 44NaCl)

20KAcetate 20 KAcetateTOTAL 72Na 70K 94Cl 96 AcetateRest Ca Gluconate (4.7mEq/l) add x2=9.4 mEqSelenium 40 mEq increment.Regular Insulin (for diabetic) 0.1-0.3(max) units insulin/gram dextrose.NOW READY TO ORDER TPNFILL OUT THAE CALCULATIONS TOTAL MLAMINO ACIDS -------------------------------------------8%DEXTROSE --------------------------------------------21%LIPIDS(20%) ---------------------------------------------200 MLTOTAL ---------------------------------------------1300 ML-------13001.NaCl (4.0 mEq/ml)------------------------------------44 mEq------- 112.Na2PO4(Na=4mEq/ml);Po4=3mM/ml)------21 mM-------------073.Na Acetate (2mEq/ml)-------------------------------------------------------

4.KCl (2mEq/ml) ----------------------------------------50 mEq------------255.K2Po4 (K=4.4mEq/ml);Po4=3mM/ml)----------------------------------6.kAcetate (2mEq/ml)--------------------------------20 mEq---------- 107.MgSo4(4mEq/ml)-------------------------------------12 mEq-----------038.Ca Gluconate(4.7mEq/ml)-----------------------9.4 mEq----------027.Sel --------------------------------------------------------------------------------------GRAND TOTAL =------------------------------------------------------------1358RATE 1358 DEVIDED BY 24 HR =56CC/HR.