Practice exercise (made-up values, not clinical guidance). A 51 kg patient has a fluid goal of 30 mL/kg/day and receives all fluid through a feeding tube. The formula is 70% free water and runs at 60 mL/h for 18 hours a day. The rest of the fluid is given as water flushes every 4 hours. What volume V is each flush? Round to the nearest whole number.
51 kg30 mL/kg/day70%60 mL/h · 18 hevery 4 h
V = mL
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). A child who weighs 4.5 kg receives 7.5% dextrose at 20 mL/h. Find the glucose infusion rate GIR in mg/kg/min. Round to two decimal places.
4.5 kg7.5%20 mL/h
GIR = mg/kg/min
3.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.
milk: 100 mLjelly: 100 mLsoup: 150 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 1 × 100 mL
I = mL
4.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 11:15 and runs by pump at 60 mL/h. How many mL V are left in the bag at 15:45?
500 mL60 mL/h11:15 → 15:45
V = mL
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: V = 129 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
30·51 = 1530 mL/day
Free water from the formula
60·18 = 1080 mL
1080·0.7 = 756 mL
Water still needed
1530 − 756 = 774 mL/day
Volume per flush
24/4 = 6 flushes
V = 774/6 = 129 mL
Answer
V = 129 mL
2.Enteral & parenteral nutrition calculations
Answer: GIR = 5.56 mg/kg/min
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.
Dextrose concentration
7.5% = 75 mg/mL
Dextrose per minute
75·20/60 = 25 mg/min
Per kilogram
GIR = 25/4.5 = 5.556 ≈ 5.56 mg/kg/min
Answer
GIR = 5.56 mg/kg/min
Shortcut: GIR = % dextrose × mL/h/(6 × kg).
3.IV fluids & fluid balance
Answer: I = 1410 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: 100 + 100 + 150 = 350 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 1·100 = 100 mL
I = 1410 mL
Answer
I = 1410 mL
4.IV fluids & fluid balance
Answer: V = 230 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.