Nutritional Requirements & Conversions

Question 1

IBW

Answer 1

male: 50 +(2.5*in>60)
female: 45.5 + (2.5&in>60)

Question 2

Dosing body weight (DBW)

Answer 2

DBW= IBW + 0.4(wt-IBW)
- use if ABW is 130% or more of IBW

Question 3

Nutrition Body Weight

Answer 3

NBW = IBW + 0.25 (wt-IBW)
use if ABT is 130% or more of IBW
- applies for calculating fluid, electrolyte and nutrition parameters

Question 4

Nitrogen balance (general)

Answer 4

• measures urinary excretion of nitrogen as urea nitrogen (urinary urea nitrogen; UUN)
• ideal goal is +3 to +5 grams

Question 5

Nitrogen Balance formula

Answer 5

Nitrogen balance = (N in) - (N out)
N in= (24 hr protein intake (g))/6.25
N out = (24 hr UUN) + factor (4g)

Question 6

Caloric needs

Answer 6

Non-stressed: 20-25 kcal/kg/dau
Trauma/stress/surgery: 25-30 kcal/kg/day
BMI 30-50: 11-14 kcal/kg/day
BMI > 50: 22-25 kcal/kg/day

Question 7

Protein Requirements

Answer 7

maintenence: 0.8-1 g/kg/d
mild to moderate stress (floor pts): 1-1.5 g/kg/d
moderate to severe stress (ICU, trauma, surgery, burn): 1.5-2 g/kg/d

Question 8

NPC Distribution

Answer 8

• Standard (70/30) - 70% dextrose, 30% fats
• adjust based on tolerance and health conditions
• 100/0 may be utilized in sepsis or bloodstream infections

Question 9

Peripheral PN (contents)

Answer 9

• Restrict final dextrose conc, to 5-10%, or total osmolarity to < 900 mOsm/L
• total mOsm/bag: (g AA10) + (g dextrose5) + (mL fat*0.3)

Question 10

1 g protein = ____ kcal

Answer 10

4 kcal

Question 11

1 g dextrose = ___ kcal

Answer 11

3.4 kcal

Question 12

Max carbohydrate utilization should be ___ mg/kg/min

Answer 12

4-5 mg/kg/min

Question 13

1 g lipids = ___ kcal

Answer 13

10 kcal

Question 14

Lipid Considerations

Answer 14

• max of 60% of caloric intake should be from lipids
• generally do 1-1.5 g/kg/day (max of 2.5g/kg/d)
• 4g/kg/d in infants/pediatrics

Question 15

Propofol provides ___ kcal/mL

Answer 15

1.1 kcal/mL

Question 16

Cycling PN

Answer 16

• infusion over about 12-18 hours per day
• transitioning to EN or PO intake
• max is about 200 mL/hr

Question 17

Standard Daily Electrolyte Range

Answer 17

• Calcium: 10-20 mEq
• Magnesium: 8-24 mEq
• Phosphorus: 15-45 mMol
• Sodium: 1-2 mEq/kg

Question 18

MIVF

Answer 18

30-40 mL/kg/day

Question 19

Phos mMol to mEq

Answer 19

1 mMol Phos = 1.4 mEq Phos

Question 20

PN daily monitoring

Answer 20

• vital signs
• intake/output
• CMP
• feeding tube placement & patency

Question 21

PN monitoring - twice weekly

Answer 21

• weight
• CBC
• prealbumin/CRP, Mg, Phos, Ca

Question 22

PN monitoring - weekly

Answer 22

• TG
• RQ/IC
• liver function tests
• albumin, transferrin, nitrogen balance
• PT/INR

Question 23

Clinical Findings of Refeeding Syndrome

Answer 23

• HYPOPHOSPHATEMIA, hypomagnesemia, hypokalemia
• respiratory distress, paresthesias, tetany, cardiac arrhythmias, hemolytic anemia

Question 24

Prevention of Refeeding Syndrome

Answer 24

• limit carbs (dextrose) to 100-150 g (on Day 1)
• limit fluids to 800 mL/day (on Day 1)
• provide about 50% of total caloric needs (on Day 1)

Question 25

Essential Fatty Acid Requirements

Answer 25

4-10% of daily calories