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MIFFLIN - ST JEOR EQUATION Activity Stress Total

KG CM YR Kcal Factor Factor Kcals

FEMALES REE = 10 X (WT) (+) ### X (HT) (-) 5 X (AGE) (-) 161
(+) (-) (-) 161 >>> -161 0

MALES REE = 10 X (WT) (+) ### X (HT) (-) 5 X (AGE) (+) 5

(+) (-) (+) 5 >>> 5 0

IRETON-JONES EQUATION
(Use for obese and for ill or injured patients in the ICU)

SPONTANEOULY BREATHING
YR KG 1 OR ZERO TOTAL
EEE = 629 (-) 11 X (AGE) (+) 25 X (WT) (-) 609 X (OBESE) EEE
(+) (-) (=) >>>
629 (-) 0 (+) 0 (-) 0 (=) >>> 629 Kcal

A = Age in years; W = actural body weight in kg; O = obesity > 30% above ideal body weight or BMI > 27 (present = 1, absent = 0); S = sex (male = 1, female = 0); T =
diagnosis of trauma (present = 1, absent = 0); B = burns (present = 1, absent = 0).

VENTILATOR DEPENDENT TOTAL


EEE = 1784 (-) 11 X (AGE) (+) 5 X (WT) (+) 244 X (SEX) (+) 239 X (TRA) (+) 804 X (BURN) EEE
(+) (+) (+) (+)
1784 (-) 0 (+) 0 (+) 0 (+) 0 (+) 0 1784 Kcal

IBW RANGE
Ideal Body Weight lbs
Actual Actual
Height Height 1st 5 ft Additional Inches Usual Body % Weight
IBW / LB (-) 10% (+)10% Weight Weight % IBW BMI %UBW
Inches Meters lbs Over 5 ft Weight
Lb kg Change
(+) (=)

Females 0 100 100 125 90 110 0.00 0.0 #DIV/0! 0.0 100

Males 0 106 106 95.4 116.6 0.00 0.0 #DIV/0! #DIV/0! #DIV/0!

Interpreting % IBW and % UBW


% IBW %UBW Nutritional Risk

Activity Factors Stress Factors >120 Obesity

Confined to Bed 1.2 Burns Infection Surgery Trauma 110-120 Overwight

Ambulatory 1.3 < 20% BSA 1.5 Mild 1.2 Minor 1.1 Skeletal 1.2 90-109 Not at Risk

20% - 40% BSA 1.8 Moderate 1.4 Major 1.2 Blunt 1.35 80-89 85-95 Mild
Closed
Head
Starvation 0.85 > 40% BSA 1.8-2.0 Severe 1.8 Injury 1.4 70-79 75-84 Moderate
<70 <75 Severe
Max mg Dex
Patient Max Dex Actual
Critical
Wt / kg Patient g/day Dex g/day

68 391680 392 300


Carbohydrate
should
- not exceed 4 mg/kg/min in the critically ill patients.
Max mg Dex Max Dex
Stable g/day Actual
(3.4 kcal/ml) should not excees 7 mg/kg/min in stable patients. Patient Dex g/day
685440 685 300
Protein - range from 1.2 - 2.0 g/kg/day in critically ill patients

0.08 - 1.0 g/kg in stable patients

may exceed > 2.0 g/kg if there are extreme losses such as in weeping wounds or large body surface area burns.

Amino acids provide 4 kcal/g with stock or base solutions ranging from 3% to 20%.

Lipids - 10% = 1.1 kcal / ml

20% = 2.0 kcal / ml

30% = 3.0 kcal / ml

PN Formulations Patient daily requirements based on nutrition assessment are: 80g protein, 2,000 kcal, 2,000 ml fluid with
maximum CHO oxidative capacity of 385 dextose / day
Diet Goal Enter lipid kcal from % of solution

2 in -1 options Diet 2000 kcal Protein 80 g Fluid 2000 ml Lipid 550 kcal
AA Solutions: 10% or 15%

Dextrose solutions: 20%, 30%, 40%, 50% or ____________% Lipid Standard Solution 500 ml

Lipid: 10% (500ml) or 20% (500ml) _______daily or _______ x per week Lipid % ml soln kcal / ml

Example 30% 500 x 3 (=) 1500 kcal


1 Determine needed lipids / day and what the solution provides. 20% 500 x 2 (=) 1000 kal

a. 10% lipid / day would provide 500 ml volume, 50 g lipid and 550 kcal 10% 500 x 1.1 (=) 550 kcal

2 Assess the best Protein (AA) volume needed to meet AA (g) requirements. Enter Pro %

a. 80 g AA divide 10 % AA concentration = 800 ml volume and 320 kcal Protein/AA 80 (/) 5.0 (=) 1600 ml

80 x 4 (=) 320 kcal


3 Calculate needed dextrose (g) by subtracting kcal from daily lipids and AA solutions
Diet kcal Lipid kcal Pro kcal Left for Dex

a. 2,000 kcal - 550 kcal (lipid) - 320 (AA) = 1,130 kcal from dextrose needed. 2000 550 320 (=) 1130 kcal

b. 1,130 kcal divide 3.4 = 332 g dextrose needed / day. 1130 ( /) 3.4 (=) 332 grams

4 Assess the best dextrose needed to meet (g) requirements Dex / g Dex / % Dextrose Volume
a. 332 g dextrose divide 50% dextrose concentration = 664 ml volume 332 (/) 50 (=) 665 ml
Round up /
b. Round to 700 ml volume to provide 350 g dextrose and 1,190 kcal. down 300 1400 ml

(Round to get even ml for PN titraiton) Dex Pro Lipid Total kcal

Actual 1130 320 550 2000


Final kcals 1020 320 550 1890 kcals
5 Calculate infusion rate per hour per total volume
24 hr
Total Soln
Infusion
ml
a. 500 ml (lipid) + 800 ml (AA) + 700 ml (dextrose) = 2,000 ml volume Rate

b. 2,000 ml divide 24 hr infusion = 83 ml / hr 3500 146 ml/hr

6 PN goal = 83 ml / hr of 10 % lipid (500 ml), 800 ml of 10 % AA, 700 ml of 50 % dextrose solution t provide
2,060 total kcal, 80 g AA, 350 g dextrose, 50 g lipid, 2,000 ml volume daily.

TNA: Maaconutrients are ordered in grams per day for this facility Diet 2000 kcals Protein 80 g 320 kcals
1 Calculate kilocalories provided by goal AA
a. 80 g AA x 4 = 320 kcal
Lipid
Lipid Lipid Grams Adj
2 Calculate kilocalories provided by desired lipid (g) kcals grams Rounded kcals
a. 2,000 kcal x 30% = 600 kcal from lipid Diet ( x ) 10 % (=) 200 22 20 200
b. 600 kcal divide 9 kcal / g = 66 g lipid (round to 65 g) Diet ( x ) 20 % (=) 400 44 40 400
c. 65 g lipid x 10 kcal / g = 650 kcal from lipid Diet ( x ) 30 % (=) 600 67 60 600
3 Determine dextrose (g) needed by subtracting kilocalories from AA and lipids.
Protein AvailableD Dextrose Adjusted
kcals Lipid extrose Grams Grams Dextrose
a. 2,000 kcal x 320 kcal (AA) - 650 kcal (lipid) = 1,030 kcal needed from dextrose Total kcals kcals Kcals Dextrose Rounded kcals
b. 1,030 kcal divide 3.4 kcal / g = 303 g dextrose (round to 300 g) 2000 320 200 1480 435 400 1360
4 PN goal: 80 g AA, 300 g dextrose, 65 g lipid to provide 1,990 total kcal in 2,000 ml volume. 2000 320 400 1280 376 300 1020
2000 320 600 1080 318 250 850
XXX Change items in red when you change Diet Calories