Critical Care >Nutrition Support

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 29–8Parenteral nutrition formula sample.

Calculate macronutrients:

Use caloric estimate (predictive equations v. kcal/kg) to estimate total calories:

1. Calculate Protein (AA) needs:

•.8-1.0 g/kg for adult maintenance

•1.2- 2.0 kg for stress, s/p surgery, wound healing
•1.5g/kg for critical illness

•≥ 2g/kg IBW for Class I, II obesity (BMI 30-40)

•≥ 2.5g/kg IBW for Class III obesity (BMI ≥ 40)
•≥ 1.5 g/kg (hemodialysis, continuous veno-venous hemofiltration)
(CHO and fat ratio can be adjusted per medical condition, for example in patients with rising worsening liver failure and rising LFTs can consider higher %CHO and lower% Lipid)

Example (using 60 kg BW):

Total Calories: 1500 kcal

1. Protein (AA):

60 kg x 1.5 g/kg = 90 g

90 g x 4 kcal/g = 360 kcal

2. Carbohydrate (Dextrose):

1500 kcal × .5 = 750 kcal

750 kcal/3.4 kcal/g = 220 g

3. Fat (Lipid):

•1500 kcal – 750 kcal (from CHO) – 360 kcal (from Protein) = 390 kcal
•390 kcal/10 kcal/g = 39 g (can be rounded to 40 g)
Calculate fluid requirements:

Grams AA/CHO/Lipid divided by [concentration of solutions] = minimum volume (ml)

•Protein (AA): 10 - 15% concentration

•Carbohydrate (CHO): standard dextrose solution- 70% concentration
•Fat: (Intralipid): 30% concentration
•Add 150 ml for additives (vitamins, minerals, trace elements, etc)
Example

90 g AA / 0.1 = 900 ml

+ 220 g dextrose / 0.7 = 314.2 ml

+ 40 g lipid / 0.3 = 133.3 ml

+ 150 ml (for additives)

Total = 1497.5 ml

Date of download: 01/01/23 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.