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RxPrep
TPN calculations (11)
| Question | Answer |
|---|---|
| Calories per mL lipid 10%? | 1.1 kcal/mL |
| Calories per mL lipid 20%? | 2 kcal/mL |
| Calories per mL lipid 30%? | 3 kcal/mL |
| Calories per gram dextrose (PN)? | 3.4 kcal/g |
| Calories per gram glycerol? | 4.3 kcal/g |
| Typical PN fat percentage? | 15–30% |
| Typical PN carbohydrate percentage? | 70–85% |
| Maximum dextrose infusion? | 4 mg/kg/min (some use 7 g/kg/day) |
| Lipids usually administered how often? | daily or 3x weekly |
| Lipids administered daily limit? | ≤60% total calories |
| Protein requirement non-stressed patient? | 0.8–1 g/kg/day |
| Protein needs for Hospitalized or malnourished? | 1.2–2 g/kg/day |
| How to calculate nitrogen? | Protein (grams)/6.25 |
| Nitrogen balance purpose? | To evaluate anabolic vs catabolic state |
| NPC definition and calculation? | Non-protein calories NPC = Calories from dextrose + calories from lipids |
| NPC:N ratio purpose? | ensure adequate non-protein energy |
| How to calculator NPC:N? | NPC / Nitrogen (in grams) |
| Steps to get NPC:N | Calculate NPC Calculate nitrogen (grams protein/6.25) Divide NPC by grams nitrogen |
| NPC:N severe stress target? | 80:1 |
| NPC:N moderate stress? | 100:1 |
| NPC:N unstressed? | 150:1 |
| Do lipid emulsions usually have soy oil? | Yes |
| Do lipid emulsions usually have glycerol? | Yes |
| Definition of BEE and TEE? | BEE: basal energy expenditure TEE: total energy expenditure |
| How is TEE different from BEE in terms of calculation? | TEE = BEE x stress factors x activity (it accounts for non-basal energy consumption) |
| How do we adjust TEE based on temp? | For every degree (C) above 37, add 12% to the calculated TEE (so a patient at 39 C would add 24% calories to their TEE) |
| Corrected Ca formula? | Corrected Ca = measured Ca + [(4 - albumin) x 0.8] |
| When do we use corrected Ca instead of measured Ca? | If albumin < 3.5 g/dL |
| Which two electrolytes have a precipitation risk when used together? | Calcium and phosphate |
| What is the safe limit for Ca/Phos? | <45 mEq/L combined |
| Which Ca salt is preferred? | Calcium gluconate |
| How do we calculate daily fluid requirement? | 30-40 mL/kg/day |
| When would reduce fluids given? | Edema, CHF, or renal disease |
| For FEEDING TUBES: How long do we hold food before/after drug administration? | Hold 1 hour before and 1-2 hours after. |
| Which drugs have interactions/complications or need adjustments when given via feeding tube? How are these drugs affected? | Warfarin (drops INR), Phenytoin (less absorption), and Levothyroxine (less absorption) |
| What trace elements can be added to a TPN? | Zinc, Copper, chromium, manganese |
| Can multivitamins be added to TPN? | Yes |
| Can insulin be added to a TPN? | Yes |
| Can famotidine be added to a TPN? | Yes, for stress-ulcer prophylaxis |
| Can PPIs be added to a TPN? | NO, not mixed into a TPN. Give separately |
| Dextrose calories? | 3.4 kcal / gram |
| Normal Ca range? | 8.5-10.5 |
| Normal albumin range? | 3.5-5.0 |
| Activity factor for bed rest? | 1.2 |
| Activity factor for ambulatory (patient getting out of bed)? | 1.3 |
| Stress factor for minor surgery? | 1.2 |
| Stress factor for infection? | 1.4 |
| Stress factor for major trauma? | 1.5 |
| Stress factor for burns? | 1.5-2 |
Created by:
cdaughtry