KELOMPOK 4

TOTAL PARENTERAL NUTRITION

Fitriani Saidi (1408062200

Jelita Qori Buana (1408062216)
Dita Febyana (1408062232)
Yosi Winda Yuliana (1408062264)
Widya Siswara M (1408062248)
 Kasus 5
A 41yo, 134 lb, 5’ 5” female is admitted for surgical removal of a large adrenal
tumour. She is to be placed on TPN in anticipation of a prolonged NPO post-
operative course.
Labs are:
sodium 139 mEq/L normal range 135 – 150 mEq/L
potassium 3.7 mEq/L normal range 3.5 – 5.0 mEq/L
chloride 102 mEq/L normal range 100 – 106 mEq/L
bicarbonate 28 mEq/L normal range 24 – 30 mEq/L
BUN 12 mg/dL normal range 8 – 20 mg/dL
creatinine 0.6 mg/dL normal range 0.6 – 1.2 mg/dL
glucose 157 mg/dL normal range 70 – 110 mg/dL, fasting
calcium 10.1 mEq/L normal range 8.5 – 10 mEq/L
phosphate 1.6 mg/dL normal range 2.6 – 4.5 mg/dL
magnesium 1.7 mEq/L normal range 1.8 – 2.5 mEq/L
albumin 3.1 g/dL normal range 3.5 – 5 g/dL (long-term nutritional status)
Calculate her nutritional needs using both the pre-set volume and the pump
methods.
 Perhitungan Tinggi, ABW, IBW, dan Feed Weight

Tinggi 5’ 5’’ ABW = 134 Ib (pound)

1 kaki = 12 inci 1 pound = 0,45 kg
1 inci = 2,54 cm ABW = 134 x 0,45 = 60,3 Kg
5x 12 = 60 inci
= 60 inci+5 inci IBW = 45,5+ 2,3( H- 60 inci)
= 65inci x 2,54 = 165,1 cm = 45,5+2,3 (65-60 inci)
= 57 Kg

Feed Weight
(ABW + IBW) : 2
= 60,3 Kg + 57 Kg = 58,65 Kg
2
 Daily Fluids Needs

>20 kg = 1500 mL + (20 mL) x (W-20 kg)

= 1500 mL + (20 mL) x (58,65-20 kg)
= 1500 mL + 440 mL
= 2273 mL

Kebutuhan cairan = 30-35 ml/Kg/hari

= 30x58,65 = 1759,5mL/hari
= 35x58,65 = 2052,75mL/hari
Rata-rata kebutuhan cairan = 1759,5+2052,75= 1906mL 2
= 1906 ml/hari ~ 2000mL/hari
 Protein requirement

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

Untuk pasien 58,65 Kg
1 g/kg/hari x 58,65 kg = 58,65 g/hari
1,2 g/kg/hari x 58,65 kg = 70,38 g/hari
Rata2 kebutuhan protein = 58,65+70,38= 64,5g/hari
2
 Non-protein calories

BEE woman = 665,1 + 9,56(W)+1,86(H)-4,68(A)

= 665,1 + 9,56 (58,65)+1,86(165)-4,68(41)
= 665,1 + 560,69 + 306,9 – 191,88
= 1340,8 ~ 1341

BEE women = 1341

Activity factor (di tempat tidur) = 1,2
Stress factor  infection = 1,5
TDE = (BEE) (activity factor) (stress factor)
TDE = 1341 x 1,2 x 1,2
= 1931,04 kcals/day ~ 1931,04 kcals/days
 Non-protein calories dan Amount

Total TPN volume Kebutuhan protein = 64,5 g/hari

2000 mL/hari Untuk per bag.nya = 32,25 g/hari
Volume untuk Protein volume= 10% AA= 50g
masing2 TPN 1000 dalam 500 mL
ml/bag Untuk 32,25 g = 32,25 g x 500 mL
2 bags/hari 50g
= 322,5mL/ bag ~ 323 mL/bag
3,5 mg/kg/min
Untuk 58,65 kg = 3,5 mg x 58,65/kg/min x kg x (24jam x 60 min)
= 295,59 mg/hari ~ 296mg/hari
Untuk 1 bag = 296 mg/hari : (2)
= 148 mg/bag

Volume dextrose
148 g x 500 ml = 740 ml
100g

Dipilih 100g in D20 W 500ml

= (100g/bag÷2) x (3,4 kcals/g)
= 170 kcal

Sehingga (1931,04 kcals ÷ 2)-170 kcals = 795,52 kcal

Jumlah kalori fat = (1931,04 kcals/2)-170 kcals
= 795,52 kcal

Gunakan 550 kcals / 500 ml lipid 20 %

= (900 kcals / 9 kcals/g) / 500 ml
= 100 g/500 ml
1 g = 9 kcal  untuk 795,52 kcal = 88,39 g ~ 88 g
Vol lipid 20% = (88/100)x500 ml = 440 mL

Vol sisa = 1000 mL- 323ml(AA)- 148 ml(dextrose)-440 ml(lipid)

= 89 mL
Total amt of kcals/day from fat and dextrose:1931,04kcals/hari (67% fat)

amt/ 1000 calories (amt) (#daily cals)/ 1000 amount/bag

Sodium 40-50 mEq 77-97 divid 87mEq
Potassium 40 mEq 77 each 77 mEq
Magnesium 8-12mEq 15-23by 1.3 19 mEq
Calcium 2-5 mEq 4-10 to get 7 mEq
Phosphate 15-25 mMol 29-48 amt/bag 38,5 mMol
 Volume to add
potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 25,67 ml
potassium chloride 2mEq/ml 25,67x4,4= 112,95-77=35,95/2=17,975=18 mL
magnesium sulfate 4mEq/ml 19/4= 4,75 ml
Volume air steril yang ditambahkan :
= 1000ml - 323ml(AA) - 148ml(dextrose) - 440ml(lipid)-48,42 (elektrolit)
= 40,58 ml
Kecepatan infus = 1000 ml/hari
= 41,66 ml/jam
TPN Worksheet using pump
Tinggi 5’ 5’’
1 kaki = 12 inci
1 inci = 2,54 cm ABW = 134 Ib (pound)
5x 12 = 60 inci 1 pound = 0,45 kg
= 60 inci+5 inci ABW = 134 x 0,45 = 60,3 Kg
= 65inci x 2,54 = 165,1 cm

IBW = 45,5+ 2,3( H- 60 inci) Feed Weight

= 45,5+2,3 (65-60 inci) (ABW + IBW) : 2
= 57 Kg = 60,3 Kg + 57 Kg = 58,65 Kg
2
 Kebutuhan Cairan
>20 kg = 1500 mL + (20 mL) x (W-20 kg)
= 1500 mL + (20 mL) x (58,65-20 kg)
= 1500 mL + 440 mL
= 2273 mL

Kebutuhan cairan = 30-35 ml/Kg/hari

= 30x58,65 = 1759,5mL/hari
= 35x58,65 = 2052,75mL/hari
Rata-rata kebutuhan cairan = 1759,5+2052,75= 1906mL
2
= 1906 ml/hari ~ 2000mL/hari
 Protein requirement
Hospitalized patient = 1-1,2 g/Kg/hari
Untuk pasien 58,65 Kg
1 g/kg/hari x 58,65 kg = 58,65 g/hari
1,2 g/kg/hari x 58,65 = 70,38 g/hari +
2
= (128,03 : 2) g/hari
= 64,52 g/hari ~ 65 g/hari
 Non-protein calories
BEEwoman = 665,1 + 9,56(W)+1,86(H)-4,68(A)
= 665,1 + 9,56 (58,65)+1,86(165)-4,68(80)
= 665,1 + 560,69 + 306,9 -191,88
= 1340,81 ~ 1341

BEE women = 1341

Activity factor (di tempat tidur) = 1,2
Stress factor  surgery = 1,2
TDE = (BEE) (activity factor) (stress factor)
TDE =1341x 1,2 x 1,2
= 1931,08 kcals/day~ 1931 kcals/day
 Amount
Total TPN volume 2000 ml/hari
Volume untuk masing2 TPN 2000 ml/bag
1 Bags/hari
 Protein volume
27,5 g in 500 ml 5,5% AA 42,5 g in 500 ml 8,5%AA 50 g in 500 ml 10% AA or
10%AA calculated volume

Kebutuhan protein = 65 g/hari

Untuk per bag.nya = 65 g/hari
Protein volume= 10% AA = 50 g dalam 500 ml
Untuk 65 g = 65 x 500 ml = 650 ml/ bag
50
 Dextrose volume (3,4 kcals/g)
3,5 mg/kg/min= g/day
100 g in D20W 500 ml 250 g in D50W 500 ml 350 g in D70W 500 ml

3,5 mg/kg/min
Untuk 42 kg = 3,5 mg/kg/min x 58,65 kg x (24jam x 60 min)
= 295,596 mg/hari ~ 296 mg/hari
Untuk 1 bag = 296 mg/hari : (1 bag/hari)
= 296 g/bag

Volume dextrose
296 g x 500 ml = 592 ml
250 g

Dipilih 250 g in D50 W 500ml

= (250 g/bag) x (1 bag) x (3,4 kcals/g)
= 850 kcal

Sehingga 1931 kcals - 850 kcals = 1081 kcal

 Fat Volume
9 kcals/g) choose one:
550kcals/500ml 10% lipid 900kcals/ 500ml of 20% lipid

Gunakan 900 kcals / 500 ml lipid 20 %

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

9 kcals = 1g  1081 kcal = 120,11 g ~ 120 g

Volume lipid 20% = (120 g /100 g) x 500 ml = 600 ml
 Daily electrolyte needs
Total amt of kcals/day from fat and dextrose:1931,04kcals/hari (67% fat)

amt/ 1000 calories (amt) (#daily cals)/ 1000 amount/bag

Sodium 40-50 mEq 77-97 divid 87mEq
Potassium 40 mEq 77 each 77 mEq
Magnesium 8-12mEq 15-23by 1.3 19 mEq
Calcium 2-5 mEq 4-10 to get 7 mEq
Phosphate 15-25 mMol 29-48 amt/bag 38,5 mMol
 Calculate the volume of each electrolyte
solution that you will add

Volume to add
potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 25,67 ml
potassium chloride 2mEq/ml 25,67x4,4= 112,95-77=35,95/2=17,975=18
magnesium sulfate 4mEq/ml 19/4= 4,75 ml
Volume air steril yang ditambahkan :
= 2000 ml – 650 ml (AA) – 592 (dextrose) – 600 ml
(lipid)-48,42 ml (elektrolit)
= 109,58 ml~ 110 ml

Kecepatan infus = 2000 ml/hari

= 83,33 ml/jam
= 1,38 ml/menit
= 28 tts/menit