EASY WAY TO CALCULATE TPN

PRADEEP SINGH MD
Cal est needs
Harris ben
For BEE: M=66.47+13.75(WT IN KG)+5(HTINCM)-6.76(AGE YRS)
F=655+9.6(WT KG)+1.7(HTCM)-4.7(AGEYRS)
Activity factor from 1.0-1.2
Stress factor 1.1-1.3 in non burn pt
Irenton-jones
On Vent 1784-11(age)+5(wt kg)+244 for Males +239 for trauma
+0 for Female
+0 if no trauma
STEP1
FIRST CALCULATE NUTRITIONAL NEEDS PER DAY
1A ~ PROTEIN/24 HOURS
(NEED 1.5 TO 2 .0 GRAM )
FOR EX. 75 KG MAN WILL NEED 75X1.5=105 GRAM
and TOTAL CALORIE NEED IS IF 1750 TOTAL (YOU
CAN CALCULATE BY HARRIS-BENEDICT)
SO 105 X4=420 CALORIE FROM PROTEIN
NOW 1750-420=1330 NPC NEED
1B~ LIPID Kcal/24 h=400?
(USUALLY 30-40%ON NON PROTEIN kCAL IF
MEETING 100%OF CALORIE NEEDS OTHERWISE
COULD BE >30%) .SO 30%OF 1330CAL=400 .
1C~ DEXTROSE Kcal/24HRS=930?
REST 1330-400(from fat)=930 FROM CARB
NOW CONVERT Kcal TO GRAM
930Kcal/24 hrsDEVIDED BY 3.4=274 GRAM DEXTROSE
(USUALLY 60%OF NON-PROTEIN Kcal IF MEETING 100%
OF CALORIE NEEDS.)
STEP 2
VOLUME CALCULATIONS
2A~.WE HAVE 15%AMINO ACID SOL FOR COMPUTERIZED ADMX
SO 105 [1A]DEVIDED BY.15=700ML
2B~WE HAVE 20%SOL FOR LIPIDS ADMIXTURE
SO 400 [1B]Kcal X.5(20%)=200 ML/D
2C~WE HAVE 70%DESTROSE SOL FOR ADMIXTURE
SO 274 [1C]DEVIDED BY .70=392ML
2D~FINAL VOLUME 1300 ML/24HR[round to nearest 100ml]
STEP3
FINAL ORDERS AT HVMC FOR 3 IN 1 TPN
3A~105 [1A]DEVIDE BY1300[2D]X100=8%AA
[round to nearest 0.5%]
3c~274(1c)devided by 1300x100=21%dextrose.
[round to nearest0.5%]
STEP 4 MICRONUTRIENTS
1.OBTAIN BMP Mg Phos
2. find pt wt in kg
3.EST Require of Na &K 1-2 mEq/kg body wt unless pt is in renal failure
Phos req 15-40 mmol/day, Ca 9-22mEq/day, Mg 8-24 mEq/day
I do not prefer to use TPN II electrolyte pkg as it complicates.
4.Go to Ca first. Needs usually 9.4 mEq/day
Mg :Except for renal failure,may start at 12-21 mEq. Start high end
if risk for refeeding syndrome.Our sol has4mEq/l of strenth
so remember that all numbers should be divisible by 4 mEq .
phos:Usual level 15 -21 mMol except for renal failure.number must
be devisible by 3 (because our sol has Po4 3mM/ml strenth)
CHECK Ca Phos ratioPhos in mmolx1.8xCa in mEq must be<300/l
Decide if you want Na or KPhos .Devide Phos by 3 to get

conversion factor Eg. 18 mmolof Phos=conver fact of 6

Na Phos has 4mEq Na or conv factor( 6)x4 mEq =24 mEq Na
KPhos has 4.4 mEq K or con factor(6)x4.4mEq=26.4 mEq K
5. Balance Na K and Cl Acetate.
Acetate =(gm of Protein devided by 150 x108 for 15%sol of
Amino acid [108 is known facor for % of AA sol]
SODIUM
POTA
CHLORIDE
ACETATE
28 NaPhos
50 KCl
50 (KCl)
76 (in TPN)
44 NaCl
44NaCl)
20KAcetate
20 KAcet
ate
TOTAL
72Na
70K
94Cl
96 Acetate
Rest Ca Gluconate (4.7mEq/l) add x2=9.4 mEq
Selenium 40 mEq increment.
Regular Insulin (for diabetic) 0.1-0.3(max) units insulin/gram dextrose.
NOW READY TO ORDER TPN
FILL OUT THAE CALCULATIONS
TOTAL ML
AMINO ACIDS -------------------------------------------8%
DEXTROSE
--------------------------------------------21%
LIPIDS(20%)
---------------------------------------------200 ML
TOTAL
---------------------------------------------1300 ML-------1300
1.NaCl (4.0 mEq/ml)------------------------------------44 mEq------11
2.Na2PO4(Na=4mEq/ml);Po4=3mM/ml)------21 mM-------------07
3.Na Acetate (2mEq/ml)------------------------------------------------------4.KCl (2mEq/ml) ----------------------------------------50 mEq------------25
5.K2Po4 (K=4.4mEq/ml);Po4=3mM/ml)---------------------------------6.kAcetate (2mEq/ml)--------------------------------20 mEq---------- 10
7.MgSo4(4mEq/ml)-------------------------------------12 mEq-----------03
8.Ca Gluconate(4.7mEq/ml)-----------------------9.4 mEq----------02
7.Sel ------------------------------------------------------------------------------------GRAND TOTAL =------------------------------------------------------------1358
RATE 1358 DEVIDED BY 24 HR =56CC/HR.