Practice exercise (made-up values, not clinical guidance). Use the Devine formula to find the ideal body weight IBW of a woman who is 170 cm tall (1 in = 2.54 cm). Round to one decimal place.
170 cmwoman1 in = 2.54 cm
IBW = kg
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). A critically ill woman is 161 cm tall and weighs 106 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 12-hour shift. The patient weighs 54 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 500 mL bag runs by pump at 125 mL/h. At 09:00, 200 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL200 mL infused125 mL/h
t = h
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: IBW = 61.4 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
170 cm/2.54 = 66.93 in
Ideal body weight (Devine)
IBW = 45.5 + 2.3·(66.93 − 60) = 61.44 ≈ 61.4 kg
Answer
IBW = 61.4 kg
2.Enteral & parenteral nutrition calculations
Answer: P = 133 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 = 106/1.61² = 40.89 kg/m²
Ideal body weight (Devine)
161 cm/2.54 = 63.39 in
IBW = 45.5 + 2.3·(63.39 − 60) = 53.29 kg
Protein goal
BMI 40 or more: 2.5 g per kg of ideal body weight.
P = 2.5·53.29 = 133.2 ≈ 133 g/day
Answer
P = 133 g/day
3.IV fluids & fluid balance
Answer: U = 2.12 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
500 + 375 + 175 + 325 = 1375 mL
Per kilogram per hour
U = 1375/(54·12) = 2.122 ≈ 2.12 mL/kg/h
Answer
U = 2.12 mL/kg/h
4.IV fluids & fluid balance
Answer: t = 2.4 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
500 − 200 = 300 mL
Time
t = 300/125 = 2.4 h
Answer
t = 2.4 h
That is about 2 h 24 min, so the bag runs out at about 11:24.