Practice exercise (made-up values, not clinical guidance). Use the Devine formula to find the ideal body weight IBW of a man who is 173 cm tall (1 in = 2.54 cm). Round to one decimal place.
173 cmman1 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 2000 mL of parenteral nutrition with final concentrations of 17.5% dextrose and 3.5% amino acids, plus 250 mL of 10% lipid emulsion (1.1 kcal/mL). Find the total energy E the patient receives in kcal per day. Round to the nearest whole number.
2000 mLdextrose 17.5%amino acids 3.5%lipid 250 mL · 1.1 kcal/mL
E = 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 102 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 runs by pump at 100 mL/h. At 21:30, 450 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL450 mL infused100 mL/h
t = h
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: IBW = 68.7 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
173 cm/2.54 = 68.11 in
Ideal body weight (Devine)
IBW = 50 + 2.3·(68.11 − 60) = 68.65 ≈ 68.7 kg
Answer
IBW = 68.7 kg
2.Enteral & parenteral nutrition calculations
Answer: E = 1745 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: 17.5·2000/100 = 350 g
amino acids: 3.5·2000/100 = 70 g
Kilocalories per component
dextrose: 350·3.4 = 1190 kcal
amino acids: 70·4 = 280 kcal
lipid: 250·1.1 = 275 kcal
Total energy
E = 1190 + 280 + 275 = 1745 kcal/day
Answer
E = 1745 kcal/day
3.IV fluids & fluid balance
Answer: U = 1.53 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
350 + 325 + 250 + 325 = 1250 mL
Per kilogram per hour
U = 1250/(102·8) = 1.532 ≈ 1.53 mL/kg/h
Answer
U = 1.53 mL/kg/h
4.IV fluids & fluid balance
Answer: t = 5.5 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 − 450 = 550 mL
Time
t = 550/100 = 5.5 h
Answer
t = 5.5 h
That is about 5 h 30 min, so the bag runs out at about 03:00.