Practice exercise (made-up values, not clinical guidance). An 84 kg adult (BMI below 30) needs 35 kcal/kg/day. The tube feed provides 1.5 kcal/mL and runs by pump for 24 hours a day. At what rate R do you set the pump, in mL/h? Round to the nearest whole number.
84 kg35 kcal/kg/day1.5 kcal/mL24 h
R = mL/h
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). Over 24 hours a patient receives 2400 mL of parenteral nutrition with final concentrations of 12.5% dextrose and 5% amino acids, plus 500 mL of 10% lipid emulsion (1.1 kcal/mL). Find the non-protein energy NPC in kcal per day. Round to the nearest whole number.
2400 mLdextrose 12.5%amino acids 5%lipid 500 mL · 1.1 kcal/mL
NPC = kcal/day
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 patient weighs 58 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 07:30 and runs by pump at 125 mL/h. How many mL V are left in the bag at 14:30?
1000 mL125 mL/h07:30 → 14:30
V = mL
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: R = 82 mL/h
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.
Energy needed
E = 35·84 = 2940 kcal/day
Daily volume
V = 2940/1.5 = 1960 mL/day
Pump rate
R = 1960/24 = 81.67 ≈ 82 mL/h
Answer
R = 82 mL/h
2.Enteral & parenteral nutrition calculations
Answer: NPC = 1570 kcal/day
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: 12.5·2400/100 = 300 g
amino acids: 5·2400/100 = 120 g
Kilocalories per component
dextrose: 300·3.4 = 1020 kcal
amino acids: 120·4 = 480 kcal
lipid: 500·1.1 = 550 kcal
Non-protein energy
NPC = 1020 + 550 = 1570 kcal/day
Answer
NPC = 1570 kcal/day
3.IV fluids & fluid balance
Answer: U = 1.99 mL/kg/h
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 urine
275 + 350 + 300 = 925 mL
Per kilogram per hour
U = 925/(58·8) = 1.994 ≈ 1.99 mL/kg/h
Answer
U = 1.99 mL/kg/h
4.IV fluids & fluid balance
Answer: V = 125 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.