TUGAS BIOFAR

PERHITUNGAN TPN
KELOMPOK 3:
Dina Rahmawati Rasyidah 1707062013
Gina Noor Habibah 1707062014
Adelita 1707062015
Triliantari Siregar 1707062016
Mas Ulfah Lestari 1707062017
Nur Anisah 1707062126
TPN
TOTAL PARENTERAL NUTRITION ADALAH TERAPI
PEMBERIAN NUTRISI SECARA IV KEPADA PASIEN
YANG TIDAK DAPAT MAKAN MELALUI MULUT

TUJUAN : MENGGANTI DAN MEMPERTAHANKAN

NUTRISI-NUTRISI PENTING TUBUH MELALUI INFUS IV
KETIKA (DAN HANYA KETIKA) PEMBERIAN
MAKANAN SECARA ORAL BERSIFAT
KONTRAINDIKASI ATAU TIDAK MENCUKUPI.
Kondisi yg memerlukan PN
Ileus obstruksi
Peritonitis
Fistula enterokutan
Sindrom malabsorpsi berat
Vomitus
Diare berat
Malnutrisi protein atau protein-
kalori
Kanker
 KASUS 1
Mrs.A 42yo, 148 lb, 5 6.5 female is admitted with nausea, vomitting, dehydration, and
inability to eat secondary to chemotherapy for breast cancer. She is to be placed on
TPN. Labs are:
sodium 133 mEq/L normal range 135 150 mEq/L
potassium 3.8 mEq/L normal range 3.5 5.0 mEq/L

chloride 99 mEq/L normal range 100 106 mEq/L

bicarbonate 32 mEq/L normal range 24 30 mEq/L
BUN 4 mg/dL normal range 8 20 mg/dL
creatinine 0.5 mg/dL normal range 0.6 1.2 mg/dL
glucose 113 mg/dL normal range 70 110 mg/dL, fasting
calcium 7.9 mEq/L normal range 8.5 10 mEq/L

phosphate 2.5 mg/dL normal range 2.6 4.5 mg/dL

magnesium 2.0 mEq/L normal range 1.8 2.5 mEq/L

preablumin < 7.0 mg/dL normal range 16 40 mg/dL (acute nutritional status)
albumin 2.3 g/dL normal range 3.5 5 g/dL (long-term nutritional status)
trigycerides 111 mg/dL desired range < 200 mg/dL (if these are high need to limit fat calories)
Calculate her nutritional needs using both the pre-set volume and the pump methods.
Analisis :
Pasien setelah kemoterapi mengalami beberapa
efek samping sehingga kebutuhan nutrisi pasien
harus tepat karena setelah kometerapi pasien
dapat mengalami diare , konstipasi, dan
malabsorbsi.

pasien mengalami penurunan Cl dan

peningkatan Bicarbicarbonat (karena pasien
muntah dan kehilangan H & Cl) Alkalosis
 42 FEMALE
169 67,192 60,274 63,733

2000

ABW = 148 Ib (pound)

Tinggi 5 6,5 1 pound = 0,454
1 kaki = 12 inci ABW = 148 x 0,454 =
1 inci = 2,54 cm 67,192 Kg
5x 12 = 60 inci
= 60 inci+6,5 inci IBW = 45,5 + [(169-152,4) x 0,89]
= 66,5 inci x 2,54 = 45,5 + [(16,6) x 0,89]
168,91 cm ~ 169 cm = 45,5 + 14,774
= 60,274 kg
Feed Weight
(ABW + IBW) : 2
= 67,192 Kg + 60,274 Kg = 63,733 Kg
2
 2000

1. Kebutuhan Cairan

Kebutuhan cairan = 30-35 ml/Kg/hari

= 30 x 63 = 1890 ml/hari
= 35 x 63 = 2205 ml/hari

Range = 1890 ml/hari 2205 ml/hari

Rata-rata = 2047,5 ml/hari = 2000 ml/hari

Jadi kebutuhan cairan perhari = 2000 ml/hari

 70

Hospitalized patient = 1-1,2 g/Kg/hari

Untuk pasien 63 Kg = 63 g/hari 75,6 g/hari
= 63 g/hari ~ 75,6 g/hari
Rata-rata = (63 g/hari + 75,6 g/hari) : 2
= 69,3 g/hari = 70 g/hari

Untuk 1 bag
 1800

BEE women = 665,1 + (9,56 x 63,733)+ (1,86 x 169)-(4,68 x 42)=1392,16

Activity factor (di tempat tidur) = 1,2

Stress factor pasien tdk mengalami infeksi, trauma dan rasa

terbakar. Dalam kondisi normal stress factor = 1,0~1,1

TDE = 1392,16 x 1,2 x (1,0~1,1)

= 1670,59~1837,65
TDE = (1670,592+1837,6512) :2
= 1.754,13 kcal/hari untuk 1 bag
 2000 1000 2

Untuk metode perset volume = Dibuat 2 bag/hari

 350

Kebutuhan protein = 70 g/hari

Untuk per bag.nya = 35 g/hari
Protein volume = 10 % AA = 50 g dalam 500 ml
Untuk 35 g = 35 x 500 ml = 350 ml/ bag
50
 ~
Yg dipilih 3,5 mg/Kg/min
Untuk 63 Kg = 0,0035 gr x 63kg x (24 jam x 60 mnt)
= 317,52 g/hari
Untuk 1 bag = 158,76 ~ 159 g/bag
Volume dextrose
350 g in D70 W 500ml
159 g x 500 ml = 227,14 ml
350 g
225 ml 1 bag 1.000ml

(225 ml) x ( 350 g/500 ml)

= 157,5 g x (3,4 Kcal/g)
= 535,5 Kcal ~ 540 kcal
 200 ml

Jumlah kalori fat = non protein-dextrose

= (1800 kcal / 2) - 540 kcal = 360 kcal

Gunakan 900 kcals / 500 ml lipid 20 %

= (900 kcals / 9 kcals/g) / 500 ml
= 100 g/500 ml

1 g = 9 kcals untuk 360 kcals = 40 g

Volume lipid 20% = (40/100) x 500 ml = 200 ml

Volume sisa = 1000 ml 350 ml (AA) 225 ml (Dextrose) 200 ml (lipid)

= 225 ml
 1800

72-90 40,5
72 36
14-21 9
3,6-9 3,15
27-45 18
Electrolite
1. Sodium = 40-50 mEq x 1.800 kcals = 72-90 mEq ~ 81 mEq
1.000 kcals
Per bag (1.000ml) = 40,5 mEq

2. Potasium = 40 mEq= 72 mEq

2
Per bag = 36 mEq

3. Magnesium 8-12 mEq= 14 21 mEq

Amount = 14 + 21 = 17,5 untuk 2 bag
2
Per bag = 9 mEq

4. Calcium 2-5 mEq= 3,6 9 mEq

Amount = 3,6 + 9 = 6,3 untuk 2 bag
2
Per bag = 3,15 mEq
Lanjutan.

5. Phospate 15-25 mMol = 27 45 mMol

Amount = 27 + 45 = 36 untuk 2 bag
2
Per bag = 18 mEq
 20
-
12
10,4
4,375
13,5

Total volume elektrolit :

30,15 ml
1. Sodium Chloride(4 mEq/ml) = 40,5 mEq (sodium) : 4
= 10 ml
2. Sodium acetate( 2 mEq/ml) = -
3. Potasium phospate (3mMol/ml)
Potasium phospate = 18 mMol (phosphate) : 3 mMol/ml
= 6 ml
4. Pottasium Klorida ( 4,4 mEq pottasium/ml)
=4,4 mEq/ml x 6ml = 26,4 mEq
Pottasium chloride = 36 (potasium) 26,4 mEq = 10,4
=5,2 ml
2
5. Magnesium sulfat (4mEq/ml) = 9mEq (Mg) : 4mEq/ml
= 2.25 ml
6. Calcium glukonat (0,465 mEq/ml) = 3.15 (Ca) : 0,465
= 6,7 ml
Total volume elektrolit : 30,15
Volume air steril yang ditambahkan :
=1000 ml - 350 ml (AA) - 225 (Dextrose) - 200 (Lipid) -
30,15 (Elektrolit)
=194,85 ml

Kecepatan infus = 2000 ml/day

= 83,3 ml/jam
= 1,38 ml/menit
Metode Using pump
 42 FEMALE
169 67 60 63

2000

Tinggi 5 6,5
1 kaki = 12 inci IBW= 45,5 + 2,3( H- 60 inci)
1 inci = 2,54 cm ABW= 148 Ib / 2,2 =45,5 +2,3(66,5-60
5x 12 = 60 inci = 67,27 Kg ~ 67 Kg inci)
= 60 inci+6,5 inci =60,45 Kg~ 60 Kg
= 66,5 inci x 2,54 =
168,91 cm ~ 169 cm

Feed Weight
ABW + IBW
= 67 Kg + 60 Kg = 63 Kg
2
1. Kebutuhan Cairan
Kebutuhan cairan = 30-35 ml/Kg/hari
= 30x63= 1890 ml/hari
= 35x63= 2205 ml/hari +
2
= (4.095 : 2) ml/hari
total ~ 2000 ml/ hari
 70

Hospitalized patient = 1-1,2 g/Kg/hari

Untuk 63 Kg = 63 g/hari- 75,6 g/hari
= 69,3 g/hari ~ 70 g/hari

Untuk 1 bag
 1800

BEE women = 1385

Activity factor (di tempat tidur) = 1,2
Stress factor pasien tdk mengalami, dalam kondisi
normal = 1-1,1
TDE = 1.385 x 1,2 x (1- 1,1)
= 1.660- 1.830
TDE = (1.660+1.830) :2
= 1.745 ~ 1800 kcal/hari untuk 1 bag
 2000 2000 1

Perhitungan metode using pump untuk 1 bag.

 700

Kebutuhan protein = 70 g/hari

Protein volume = 10 % AA= 50 g dalam 500 ml
Untuk 70 g = 70 x 500 ml = 700 ml/ bag
50
 ~
Yg dipilih 3,5 mg/Kg/min
Untuk 63 Kg = 0,0035 gr x 63kg x (24 jam x 60 mnt)
= 317,52 g/hari 1 bag

Volume dextrose
350 g in D70 W 500ml
317 g x 500 ml = 452,85 ml
350 g 450 ml

(450 ml) x ( 350 g/500 ml) = 315 x (3,4 Kcal/g)

= 1071 Kcal
 405 ml

Jumlah kalori fat = non protein-dextrose

= (1800 kcal ) - 1071 kcal = 729 kcal

Gunakan 900 kcals/500 ml lipid 20 %

= (900 kcals/9 kcals/g) : 500 ml
= 100 g/500 ml
1 g = 9 kcals, untuk 729 kcals = 81 g

Volume lipid 20% = (81/100) x 500 ml = 405ml

Volume sisa = 2000 ml 700 ml (AA) 450 ml (dextrose) 405 ml (lipid)
= 445 ml
 1800
Olit
72-90 81
72 72
14-21 17,5
3,6-9 6,3
27-45 36
 20
-
12
10,4
4,375
13,5

Total volume elektrolit : 60.275 ml

Volume air steril yang ditambahkan :
=2.000ml 700 ml (AA) 450 ml (dextrose) 405 ml (lipid) 60,275
ml (elektrolit)
=203,8 ml

Kecepatan infus = 2000 ml/day

= 83,3 ml/jam
= 1,38 ml/menit
 Terimakasih
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