• COURSE NAME: CC &EN

• COURSE CODE:SHS.514 lec.20

• CREDIT HOURS: 3hrS
• INSTRUCTOR: Saba Nadeem Dar

School of Health Sciences

University of Management
and technology
 Learning outcomes
• Electrolytes, vitamins & minerals calculations
• Fluid requirement
• PN formulas
• Infusion rate calculation
• Case studies
Fluid requirements
 Electrolytes
• Sodium
• If the total amount of sodium in the ECFV is
elevated, the size of the ECFV also increases,
which may lead to a state of volume overload.
• Insufficient sodium in the ECFV compartment
results in volume depletion
• Hyponatremia is defined as a serum sodium
concentration of less than 135 mEq/L.

• It is also the most common electrolyte disorder

seen in hospitalized patients

• Hypernatremia is defined as serum sodium greater

than 145 mEq/L
• Potassium
• Potassium plays an important role in
maintaining cell volume, enzyme function,
protein synthesis, cell growth, neuromuscular
activity, and hydrogen ion concentration (pH)
• Hypokalemia occurs in degrees of significance:
mild-to-moderate hypokalemia is a concentration
of 2.5 to 3.5 mEq/L,
• severe hypokalemia
• is a concentration of less than 2.5 mEq/L.
• Hyperkalemia is defined as a serum potassium
concentration greater than 5.5 mEq/L.
• Severe hyperkalemia at concentrations greater
than 6.5 mEq/L
• Magnesium
• It serves as a cofactor in more than 3,000 enzyme
reactions involving ATP

• Hypomagnesemia occurs in an estimated 10% to

20% of patients in general medicine wards and
60% to 65% of patients in ICU

• Severe magnesium depletion (<1.0 mEq/L)

• Hypermagnesemia is defined as serum
magnesium concentrations greater than 2.5
mEq/L.
• Phosphorus
• It is a cofactor in most enzyme systems and a major
component in ATP production

• Hypophosphatemia is defined as serum concentrations

less than 2.5 mg/dL.

• Hyperphosphatemia is defined as a serum phosphorus

value of more than 4.5 mg/dL and usually results from
impaired excretion due to renal insufficiency
• Calcium
• An ionized calcium level of 3.2 to 4 mg/dL is
considered a mild depletion; severe depletion is
characterized as a level less than 2.6 mg/dL

• Calcium gluconate is preferred for PN because it

is most stable in solution.
• The Safe Practices Committee recommends an
average provision of 10 to 15 mEq/d in PN
• A patient has severe hypercalcemia if the total
serum value is greater than 11 mg/dL or the
ionized measurement is more than 5.5 mg/dL.

• Calcium should be reduced or eliminated in

the PN solution until the condition resolves.
 Infusion Rate
• Carbohydrate infusion rate
• Max. 5mg/kg/min
• CHO IR=
Total dextrose in mg/Wt.(kg)/24
hours/60 min.
• Lipid IR= 1g/kg/day
Parenteral nutrition- Cardiac Surgery &
Burn Injury
Dextrose solutions
Amino acid solutions
Lipid solutions
Disease specific amino acid solutions
• PPN: < 2 weeks
• TPN: >2 weeks
• PPN (10-25% dextrose), start with 10%
dextrose solution
• < 900 mOsm
• Iron should not be given parenterally because
it is not compatible with lipid

• Iron dextran can be given parenterally but not

with lipid
• CHO
Minimum 100g/d require to prevent from
proteolysis
• Minimum requirement for healthy adult as a
part of DRI is 130g
• Fat
• 25%-35%

• Lipid up to 50% can be given to provide <900

mOsmolar solution
• 70kg weight
• Calories= 1750Kcal.
• Protein= 105g/d
• Fat= 48g/d
• Dextrose: 233g/d
• Fluid= 70*35= 2450ml/d
• Require nutrition support for 7-10 days
• Dextrose= 233/2.4L= 97*5g= 485 mOsm
• Protein= 105/2.4L= 43.7g*10= 437 mOsm
• Fat= 48/2.4L= 20g*0.67= 13 mOsm
• Electrolytes= 200/2.4L= 83*2= 166 mOsm
• Total= 1101 mOsm
• Fat (50%) = 150/100*50= 80g
• Protein (18%) = 1750/100*18= 79g
• Dextrose= 1750 – (875+315)= 560/3.4=
164g/d
• Fat= 80g/2.4= 33*0.67= 22 mOsm
• Protein= 79g/2.4= 33*10= 330 mOsm
• Dextrose= 164g/2.4= 68*5= 340 mOsm
• Electrolytes= 200 mOsm
• Total= 892 mOsm
 Cardiac surgery
• Provide nutrition support recommendation for
post cardiac surgery patient (Age: 54Y, Ht.
5.4’’, wt. 60kg, gender: female). She is unable
to take oral diet for >14 days.
 Burn Injury
• Provide nutrition support recommendation for
a patient (male) of weigh 57kg, ht.5.5’, and
age 33Y, admitted in ICU with 55% TBSA
burned.
???
Thank You!