Practice exercise (made-up values, not clinical guidance). Use the Devine formula to find the ideal body weight IBW of a woman who is 161 cm tall (1 in = 2.54 cm). Round to one decimal place.
161 cmwoman1 in = 2.54 cm
IBW = kg
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). Over 24 hours a patient receives 1200 mL of parenteral nutrition with final concentrations of 10% dextrose and 6% amino acids, plus 250 mL of 20% lipid emulsion (2 kcal/mL). Find the non-protein kilocalorie to nitrogen ratio NPC : N (the number x in x : 1). Round to the nearest whole number.
1200 mLdextrose 10%amino acids 6%lipid 250 mL · 2 kcal/mL
NPC : N =
3.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 12:30 and runs by pump at 120 mL/h. How many mL V are left in the bag at 16:00?
1000 mL120 mL/h12:30 → 16:00
V = mL
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: IBW = 53.3 kg
Needs and free water: energy needs are often estimated as kcal/kg/day × weight and protein needs as g/kg/day × weight. A formula is only partly water, so its free water = volume × water fraction; water flushes make up the rest of the daily fluid goal. Ideal body weight (Devine): IBW = 50 kg + 2.3 kg for every inch over 5 feet (60 in) for men, and 45.5 kg + 2.3 kg per inch over 60 in for women; 1 in = 2.54 cm. The formula is meant for adults at least 152.4 cm (5 ft) tall. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Height in inches
161 cm/2.54 = 63.39 in
Ideal body weight (Devine)
IBW = 45.5 + 2.3·(63.39 − 60) = 53.29 ≈ 53.3 kg
Answer
IBW = 53.3 kg
2.Enteral & parenteral nutrition calculations
Answer: NPC : N = 79
Parenteral nutrition: dextrose provides 3.4 kcal/g, amino acids 4 kcal/g and lipid emulsion the kcal/mL stated (2 kcal/mL for 20%, 1.1 kcal/mL for 10%). Grams = % × mL/100. Non-protein kcal (NPC) = dextrose + lipid kcal; nitrogen = protein/6.25. The glucose infusion rate (GIR) in mg/kg/min = dextrose mg/(kg × minutes). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Grams of dextrose and amino acids
dextrose: 10·1200/100 = 120 g
amino acids: 6·1200/100 = 72 g
Kilocalories per component
dextrose: 120·3.4 = 408 kcal
amino acids: 72·4 = 288 kcal
lipid: 250·2 = 500 kcal
Non-protein kcal and nitrogen
NPC = 408 + 500 = 908 kcal
N = 72/6.25 = 11.52 g
Ratio
NPC : N = 908/11.52 = 78.82 ≈ 79 : 1
Answer
NPC : N = 79
Ratios of about 150 : 1 are typical for stable patients; lower ratios give relatively more protein.
3.IV fluids & fluid balance
Answer: B = −115 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Total intake
oral: 120 + 240 = 360 mL
ice chips: 240/2 = 120 mL
IV infusion: 50·8 = 400 mL
IV antibiotic: 2·100 = 200 mL
total intake = 1080 mL
Total output
175 + 375 + 400 + 175 + 70 = 1195 mL
Balance
B = 1080 − 1195 = −115 mL
Answer
B = −115 mL
Negative: the patient lost more fluid than went in.
4.IV fluids & fluid balance
Answer: V = 580 mL
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.