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    Ay Chan
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    This document provides equations and guidelines for estimating basal energy expenditure, stress factors that increase calorie needs, daily protein requirements for different clinical situations, electrolyte maintenance needs, fluid requirements based on weight, lipid and dextrose calorie contributions to total calories, blood gas disorders and their characteristics, common fluid compositions for outputs like diarrhea and ileostomy, and abnormalities in fluid and electrolyte management during TPN along with their predisposing factors and management approaches.

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    This document provides equations and guidelines for estimating basal energy expenditure, stress factors that increase calorie needs, daily protein requirements for different clinical situations, electrolyte maintenance needs, fluid requirements based on weight, lipid and dextrose calorie contributions to total calories, blood gas disorders and their characteristics, common fluid compositions for outputs like diarrhea and ileostomy, and abnormalities in fluid and electrolyte management during TPN along with their predisposing factors and management approaches.

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    21 views6 pages

    Nutrition

    Uploaded by

    Ay Chan
    This document provides equations and guidelines for estimating basal energy expenditure, stress factors that increase calorie needs, daily protein requirements for different clinical situations, electrolyte maintenance needs, fluid requirements based on weight, lipid and dextrose calorie contributions to total calories, blood gas disorders and their characteristics, common fluid compositions for outputs like diarrhea and ileostomy, and abnormalities in fluid and electrolyte management during TPN along with their predisposing factors and management approaches.

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    Attribution Non-Commercial (BY-NC)
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    of 6

    Energy Requirement Equations Basal Energy Expenditure (BEE) Harris-Benedict Men: 66 + (13.7 x W) + (5.0 x H) (6.8 x A) Women: 655 + (9.

    .6 x W) + (1.7 x H) (4.7 x A) W (Kg) H (cm) A(years) STRESS FACTORS (% of BEE to provide daily calorie needs) Starvation 0.85 1.0 Normal / Non-Stressed 1.2 1.3 S/P elective surgery w/o complications 1.25 1.35 Mod stress from chronic illness 1.35 1.5 Sev stress from acute illness, severe infection, trauma, or ventilation 1.5 Burns > 20% of total BSA 2 or >

    EST. DAILY PROTEIN REQUIREMENTS

    Normal / Non-Stressed 0.8 g/Kg Oncology/Stressed/Surgical 1 1.5 g/Kg Sev stress/burns/mult trauma 1.5 2.5 g/Kg Bone marrow transplant 2 g/Kg* Renal failure (no dialysis) 0.6 0.8 g/Kg Renal failure (w dialysis) 1.2 1.5 g/Kg** Hepatic encephalopathy 0.4 g/Kg * unless in renal failure ** depends on BUN/Scr NITROGEN BALANCE (+2 to +5 is goal) N2 Balance = (N2 in) (N2 out) N2 in = Protein intake (g) / 6.25* N2 out = 24 hour urine urea Ns (UUN) + 4** * 6.25 g protein provides 1 g Nitrogen (standard oral diet) ** where 4 = insensible N2 losses (stool, sweat, hair, etc.)

    Electrolyte Maintenance Sodium Chloride 1-2-3 mEq/Kg/day Acetate Phosphate Potassium Chloride 0.5-1-2 mEq/Kg/day Acetate Phosphate 12-15 Mol/1000kcal Calcium Gluconate 5 mEq/L Magnesium Sulfate 8-24 mEq/day 12-16 mEq/day BOLD indicates most appropriate DAILY FLUID REQUIREMENTS Based on weight First 10 Kg 100 mL/Kg Second 10 Kg 50 mL/Kg All Kg > 20 Kg 20 mL/Kg OR 30-35 mL/Kg (25 mL/Kg for elderly patient)

    LIPID CALORIES 10% fat 20% fat Daily Dose 50 kcal/day 1000 kcal/day Every 275 kcal/day 500 kcal/day Other Day Mon/Thur ONLY 157 kcal/day 286 kcal/day

    Dextrose Calories = 3.4 kcal/g Protein Calories = 4 kcal/g BLOOD GASES pH / PCOs / HCO3 / %O2 Blood Gas Disorders pH HCO3 pCO2 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

    FLUID COMPOSITIONS (mEq/L) Na K Cl HCO3- L/day Diarrhea 50 35 40 45 varies Ileostomy 140 20 100 25 0.5 - 2.0 Gastric 80 10 100 -2.0 Bile 145 5 100 40 1.5 Pancreatic 140 5 75 85 0.75-1.0 Fluid and Electroylte Abnormalities in TPN Management [PF = Predisposing Factors] [MGT = Management] Hypovolemia PF-GI losses, osmotic diuresis; MGT- increased fluid intake Hypervolemia PFrenal failure, excess fluid intake; MGT-decreased fluid intake Hyponatremia PF-GI losses, fluid overload, diuretics; MGT-varies with cause Hypernatremia PF-dehydration; MGTincrease fluid intake Hypokalemia PF-GI losses, diuretics, anabolism; MGT-increase K+ intake Hyperkalemia PF-renal failure; MGTdecrease K+ intake Hypophosphatemia PF-phosphate binding antacids, anabolism, PO4-free dialysis; MGT-D/C PO4 binders, increase phosphate intake Hyperphosphatemia PF-renal failure; MGT-decrease phosphate intake

    Hypomagnesemia PF-diarrhea, malabsorption, anabolism; MGT-increase Mg++ intake Hypermagnesemia PF-renal failure; MGTdecrease Mg++ intake Hypercalcemia PF-cancer, hyperparathyroidism; MGT-decrease Ca++ in TPN, cautious volume expansion, drug treatment Hypocalcemia PF-hypoalbuminemia, chronic renal failure; MGT-increase Ca++ intake in CRF only Metabolic Acidosis PF-diarrhea, high output fistula, renal failure, excess amino acid intake; MGT-decrease Cl- in TPN, increase acetate in TPN Metabolic Alkalosis PF-gastric losses; MGT-increase Cl- in TPN, decrease acetate in TPN

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