Practice exercise (made-up values, not clinical guidance). A 58 kg adult (BMI below 30) needs 35 kcal/kg/day. The tube feed provides 1 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.
58 kg35 kcal/kg/day1 kcal/mL24 h
R = mL/h
2.Enteral & parenteral nutrition calculationsHard
Practice exercise (made-up values, not clinical guidance). An 81 kg adult receives 2000 mL of parenteral nutrition containing 10% dextrose, infused over 24 hours. Find the glucose infusion rate GIR in mg/kg/min. Round to two decimal places.
81 kg2000 mLdextrose 10%24 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.
soup: 180 mLtea: 240 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
4.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 150 mL/h. At 06:30, 250 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL250 mL infused150 mL/h
t = h
3Solutions
1.Enteral & parenteral nutrition calculations
Answer: R = 85 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 = 35·58 = 2030 kcal/day
Daily volume
V = 2030/1 = 2030 mL/day
Pump rate
R = 2030/24 = 84.58 ≈ 85 mL/h
Answer
R = 85 mL/h
2.Enteral & parenteral nutrition calculations
Answer: GIR = 1.71 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 in the bag
10·2000/100 = 200 g = 200 000 mg
Minutes of infusion
24·60 = 1440 min
Glucose infusion rate
GIR = 200 000/(81·1440) = 1.715 ≈ 1.71 mg/kg/min
Answer
GIR = 1.71 mg/kg/min
3.IV fluids & fluid balance
Answer: I = 1070 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: 180 + 240 = 420 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 1·50 = 50 mL
I = 1070 mL
Answer
I = 1070 mL
4.IV fluids & fluid balance
Answer: t = 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 − 250 = 750 mL
Time
t = 750/150 = 5 h
Answer
t = 5 h
That is about 5 h 00 min, so the bag runs out at about 11:30.