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PN Homework Assignment 19

The document provides two practice problems for calculating total parenteral nutrition (TPN) formulations. For the first problem, the assistant increases the protein provision to 1.2 gm/kg and dextrose to 1.3 gm/kg/min to better meet the patient's estimated calorie needs. For the second problem, the assistant calculates a TPN formulation for a 45-year old male patient that provides 25 kcal/kg, 1.1 gm/kg of protein, and 1.4 gm/kg/min of dextrose to meet the patient's estimated needs. The assistant recommends additional fluid flushes to meet the total fluid volume needs.

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Celeste OMealy
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429 views

PN Homework Assignment 19

The document provides two practice problems for calculating total parenteral nutrition (TPN) formulations. For the first problem, the assistant increases the protein provision to 1.2 gm/kg and dextrose to 1.3 gm/kg/min to better meet the patient's estimated calorie needs. For the second problem, the assistant calculates a TPN formulation for a 45-year old male patient that provides 25 kcal/kg, 1.1 gm/kg of protein, and 1.4 gm/kg/min of dextrose to meet the patient's estimated needs. The assistant recommends additional fluid flushes to meet the total fluid volume needs.

Uploaded by

Celeste OMealy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as ODT, PDF, TXT or read online on Scribd
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Celeste O’Mealy

NUTR 407-MNT I lab

Breanda O’Day

10 October 2019

Practice PN Calculations-Homework Assignment

1. You are consulted to make recs for TPN for a 55 y.o. female (45
kgs). The current formula is 400mL 10% AA, 100mL 70%
dextrose, 200mL 20% lipid.

Estimated needs:
20-25 kcals/Kg = 900 –1125 kcal
1.2-1.5 gms protein/kg = 54 – 68 gms
25-30 mL/kg = 1125 – 1350 ml

Calculate the current formula provision of:

 Gms of dextrose, kcals provided and mg/kg/min


o 100 ml x .70=70 gm
o 70 gm x 3.4 kcal = 238 kcal
o 70 gm / 45 kg / 1.44= 1 gm/kg/min

 Gms of protein, kcals and gm/kg


o 400 ml x .10= 40 gm
o 40 gm x 4 kcal = 160 kcal
o 40 gm/45 kg = 0.89 gm/kg

 Lipid
o 200 ml x .2= 40 gm
o 40 gm x 10 kcal = 400 kcal

 Total Kcals of the TPN =798 kcal / 45 kg= 15 kcal/kg


 % AA’s = 160 kcal / 798 kcal= 20%

 % lipids = 400 kcal / 798 kcal = 50%

 % dextrose = 238 kcal /798 kcal = 30%

 NPC:N2 ratio = 100:1


o 40 gm/ 6.25 = 6.4 g N2
o 638 kcal / 6.4 = 100:1

Protein provision: 40 gm pro / 45 = 0.89 gm/kg

What would you do different to better meet this patients’ estimated


needs? Hint: Show your new provision.
I’m going to increase protein to 1.2 gm/kg =216 kcal and I’m
going to increase dextrose to 1.3gm/kg/min= 289 kcal, to better meet
pt kcal needs. The fluids provided only supply 721 ml/d and I would
provide an additional 404-629 ml/d to meet pt needs through periodic
fluid flushes of 200 ml two to three times per day.

New provision:
Gms of dextrose, kcals provided and mg/kg/min
o 121 ml x .70=85 gm
o 85 gm x 3.4 kcal = 289 kcal
o 85 gm / 45 kg / 1.44= 1.3 gm/kg/min

 Gms of protein, kcals and gm/kg


o 400 ml x .10= 40 gm
o 40 gm x 4 kcal = 160 kcal
o 54 gm pro / 45 kg = 1.2 gm/kg

Total Kcals of the TPN =905 kcal / 45 kg= 20 kcal/kg

 % AA’s = 216 kcal / 905 kcal= 24%

 % lipids = 400 kcal / 905 kcal = 44%


 % dextrose = 289 kcal / 905 kcal = 32%

 NPC:N2 ratio = 100:1


o 54 gm/ 6.25 = 8.6 g N2
o 689 kcal / 6.4 = 80:1

2. A 45 y.o. male (75 kgs) adm with an extensive resection for


colon CA. A PICC line is in place. What are your
recommendations for parenteral support?

Estimated needs:
23-25 kcals/Kg = 1725-1875 kcal/d
1.3-1.5 gms protein/kg = 98-113 gm/d
25-30 mL/kg = 1875-2250 ml/d

Show calculations of your formula:

 Gms of dextrose, kcals provided and mg/kg/min


215 ml x .70=151 gm
151 gm x 3.4=513 kcal
151gm/75kg/1.44=1.4 gm/kg/min

 Gms of protein, kcals and gm/kg

o 1000 ml x .10= 100 gm


o 100 gm x 4 kcal = 400 kcal
o 100 gm/75 kg = 1.1 gm/kg

 Lipids:
o 475 ml x .20= 95 gm
o 95 gm x 10 kcal = 950 kcal

 Total Kcals of the TPN = 1863 kcal = 25 kcal/kg


 % AA’s = 22%

 % lipids =51%

 % dextrose = 28%

 NPC:N2 ratio = 91:1


o 100 gm / 6.25= 16 gm N2
o 1463 kcal /16 gm N2= 91:1

Recommendation in grams and volume:


● Recommendation for protein: 100gm of protein/.10 = 1 L solution
● Recommendation for CHO: 151 gm of CHO/ .70 = 215 mL solution
● Recommendation for Lipid: 95 gm of lipid/ .20 = 475 ml solution
● Recommendation for fluid: 185-560 ml additional solution in the
form of fluid flushes of 200 ml one to three times per day.
• 1875 ml - 1690 ml= 185 ml
• 2250 ml – 1690 ml=560 ml

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