Calculations III Flashcards
Enteral nutrition (EN):
Uses the GI tract
- if the GI tract is working then, enteral nutrition is preferred.
Parenteral nutrition (PN):
also referred to as TPN “total parenteral nutrition”
Delivered into a vein through a peripheral or central line.
parenteral nutrition (PN) requires a filter due to the risk of a precipitate.
They are classified as High-alert medications by the ISMP.
1) peripheral line-
2) central line- allows for a higher osmolarity and wider variation in pH.
ex. PICC line, Hickman line, Broviac line, Groshong line
- delivers calories into a vein through a peripheral or central line.
Calorie Sources:
Carbohydrates:
Enteral route-
parenteral route-
Fat:
Enteral route-
Parenteral route-
Protein:
Enteral route-
Parenteral route-
Carbohydrates:
Enteral route- 4 kcal/gram
parenteral route- 3.4 kcal/gram ex. dextrose
Fat:
Enteral route- 9 kcal/gram
Parenteral route- kcal/mL (Product-specific)
- propafal
- clevidipine
“ when we give fat as a energy source parenterally, the energy kcals is determined by the volume”
Protein:
Enteral route- 4 kcal/gram
Parenteral route- 4 kcal/gram
Calories Provided from macronutrient: Given (PN) parenterally
dextrose monohydrate
dextrose monohydrate = 3.4 kcal/gram
Calories Provided from macronutrient: Given (PN) parenterally
glycerol/glycerin
glycerol/glycerin = 4.3 kcal/gram
Calories Provided from macronutrient: Given (PN) parenterally
injectable lipid emulsion (ILE) 10%
ILE 10% = 1.1 kcal/mL
Calories Provided from macronutrient: Given (PN) parenterally
injectable lipid emulsion (ILE) 20%
(Intralipid, Smoflipid)
ILE 20% = 2 kcal/mL
Calories Provided from macronutrient: Given (PN) parenterally
injectable lipid emulsion (ILE) 30%
ILE 30% = 3 kcal/mL
Calories Provided from macronutrient: Given (PN) parenterally
Amino Acid solutions
(Aminosyn, FreAmine,)
Amino Acid solutions = 4 kcal/gram
Parenteral Nutrition is an option for patients who are not able to receive adequate nutrition via the GI tract for more than > 5 days.
Determining Fluid Needs:
Fluid requirements are determined first when designing a PN regimen.
When weight is greater > than 20kg: Use equation:
Fluid requirement = 1500mL + [(20mL) x (weight in kg - 20)]
Use patients total body weight in calculations unless told otherwise.
(NPC) non-protein calories
Determining Caloric Needs:
(BEE) Basal Energy Expenditure: “basically doing nothing else”
- is the energy expenditure in the resting state.
How much energy it takes you to lie in a bed and breath.
(TEE) Total Energy Expenditure:
- is a measure of the BEE plus excess metabolic demands as a result of stress, the thermal effects of feeding and energy expenditure from activity.
TEE equation =
TEE = BEE x activity factor x stress factor
Protein is used to either repair or build muscle cells or as an energy source.
ambulatory, non-hospitalized (non-stressed): 0.8-1g/kg/day
Hospitalized or malnourished: 1.2 - 2g/kg/day
Nitrogen Balance:
Nitrogen intake =
grams of protein intake / 6.25
There is ________ grams of Nitrogen for each __________ gram of protein.
There is 1 gram of nitrogen for each 6.25 grams of protein.
Non-Protein Calories (NPC) to Nitrogen Ratio (N):
Determined by dividing the grams of total non-protein calories (dextrose + lipids) by the nitrogen.
Desirable NPC:N ratios are:
_______ the most severely stressed patients
_______ severely stressed patients
_______ unstressed patient
80:1 the most severely stressed patients
100:1 severely stressed patients
150:1 unstressed patient
“ex. so there should be 80kcal from non-protein sources per 1 gram of nitrogen”
Branded amino acid solutions commonly used for PN include:
Amiosyn
FreAmine
Travasol
TrophAmine
Clinisol
Carbohydrates:
__________ is the primary energy source.
Glucose
carbohydrates from food or in (EN) enteral nutrition formulas provide _____________
4 kcal/gram
carbohydrates in (PN) parenteral nutrition “dextrose” provide ______________
3.4 kcal/gram
Occasionally, glycerol is used as an alternative to dextrose monohydrate in patients with impaired insulin secretion.
Glycerol in (PN) provides ___________ kcal/gram
4.3 kcal/gram
FAT:
In (EN) enteral formulations, fat provides ___________ kcal/gram
9 kcal/gram
In (PN) parenteral formulations, fat provides __________ kcal/mL
depends on fat component of product
ex. a 10% (ILE) injectable lipid emulsion provides 1.1 kcal/mL
Intralipid, Smoflipid (20% only)
(ILE) injectable lipid emulsions
If Lipids are given once weekly, divide the total calories by 7 to determine the daily amount of fat the patient receives
Lipid emulsions can not be filtered through 0.22 micron filters; __________ micron filters must be used.
1.2
Some medications are formulated in a lipid emulsion:
propofol
clevidipine
Electrolytes in (PN) parenteral nutrition:
_______1____ is the principal extracellular cation.
_____2______ is the principal intracellular cation.
_____1____ may need to be reduced in renal disease or cardiovascular disease, including hypertension.
_____2____ may need to be reduced in renal or cardiovascular disease.
1) sodium
2) potassium
sodium (Na) comes in many different concentrations:
normal saline =
1/2 normal saline =
normal saline = 0.9%
1/2 normal saline = 0.45%
Hypertonic saline (greater than 0.9%) is dangerous if used incorrectly.
Sodium can be added to (PN) parenteral nutrition as either:
1)
2)
3)
1) sodium chloride (NaCl)
2) sodium acetate (NaC2H3O2)
3) sodium phosphate (NaPO4)
If acidosis is present, which sodium formulation should be used?
sodium acetate
” sodium acetate is converted to sodium bicarbonate and may help correct the acidosis”.
Normal reference range for Na:
135-145 mEq/L
Normal reference range for K:
3.5 - 5 mEq/L
potassium is eliminated renally, so if patients develop kidney disease then potassium will creep up and elevate. Something to monitor.
Potassium (K) can be provided in what forms?
1)
2)
3)
1) potassium chloride (KCl)
2) potassium phosphate (KPO4, KPhos)
3) potassium acetate (KC2H3O2)
“same salt forms as sodium”
Normal reference range for phosphate (PO4):
2.3-4.7 mg/dL
Phosphate (PO4) can be provided by which forms?
1)
2)
But with these two formulations, they DO NOT provide equivalent amounts of phosphate.
Also too Note: (PN) parenteral nutrition orders for phosphate should be written in mmol of phosphate.
1) sodium phosphate
2) potassium phosphate
Calcium (Ca), total reference range: ______1_______
Calcium (Ca), ionized reference range:__2_____
1) 8.5-10.5 mg/dL or mEq/L
2) 4.5-5.1 mg/dL or mEq/L
The normal serum Calcium level is __________.
Almost half of serum calcium is bound to _________.
So if albumin levels are low, then the measured serum calcium concentration will falsely report _________
8.5-10.5 mg/dL or mEq/L
albumin
low.
If albumin is low (______1____), then the calcium level must be corrected with the equation _____2____.
1) albumin < 3.5g/dL
2) Ca corrected (mg/dL) = (calcium reported (serum)) + [(4 - albumin) x 0.8]
What is the normal reference range for albumin:
3.5-5 (g/dL)
