Practice exercise (made-up values, not clinical guidance). A 61 kg patient has a fluid goal of 35 mL/kg/day and receives all fluid through a feeding tube. The formula is 76% free water and runs at 85 mL/h for 18 hours a day. The rest of the fluid is given as water flushes every 6 hours. What volume V is each flush? Round to the nearest whole number.
61 kg35 mL/kg/day76%85 mL/h · 18 hevery 6 h
V = mL
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). A critically ill woman is 167 cm tall and weighs 159 kg. The practice protocol gives 2 g of protein per kg of ideal body weight (Devine) per day if the BMI is 30 to under 40 kg/m², and 2.5 g/kg of ideal body weight per day if the BMI is 40 kg/m² or more. Find the protein goal P in g/day. Round to the nearest whole number.
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 total intake I in mL.
water: 200 mLtea: 150 mLsoup: 150 mLIV infusion: 125 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
4.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 60 mL/h. At 12:00, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL150 mL infused60 mL/h
t = h
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: V = 243 mL
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.
Fluid goal
35·61 = 2135 mL/day
Free water from the formula
85·18 = 1530 mL
1530·0.76 = 1163 mL
Water still needed
2135 − 1163 = 972.2 mL/day
Volume per flush
24/6 = 4 flushes
V = 972.2/4 = 243.1 ≈ 243 mL
Answer
V = 243 mL
2.Enteral & parenteral nutrition calculations
Answer: P = 147 g/day
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. Obesity in critical illness (ASPEN/SCCM 2016): BMI = weight/height² (kg/m²). The protein goal is 2 g/kg of ideal body weight per day for BMI 30–40 and up to 2.5 g/kg of ideal body weight per day for BMI 40 and above. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Body mass index
BMI = 159/1.67² = 57.01 kg/m²
Ideal body weight (Devine)
167 cm/2.54 = 65.75 in
IBW = 45.5 + 2.3·(65.75 − 60) = 58.72 kg
Protein goal
BMI 40 or more: 2.5 g per kg of ideal body weight.
P = 2.5·58.72 = 146.8 ≈ 147 g/day
Answer
P = 147 g/day
3.IV fluids & fluid balance
Answer: I = 1700 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.
Add the intake
oral: 200 + 150 + 150 = 500 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 2·100 = 200 mL
I = 1700 mL
Answer
I = 1700 mL
4.IV fluids & fluid balance
Answer: t = 14.2 h
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.
Volume left
1000 − 150 = 850 mL
Time
t = 850/60 = 14.17 ≈ 14.2 h
Answer
t = 14.2 h
That is about 14 h 10 min, so the bag runs out at about 02:10.