TPN short note by S.

Wichien (SNG KKU)

Steps
1. BW

Example
50 kg

2. Total Energy requirement = 30 kcal x BW

1500 kcal

3. Fat solution
- Requirement = 1 gm/kg/day ( step 0.60.81)
- Regimen = 20% intralipid or 20% clinoleic
- cc x 5
- 1 gm = 10 kcal

50 gm/d
20% intralipid
250 ml/d
500 kcal/d

3. Amino solution
- Requirement = 1 gm/kg/day (step 11.21.4)
- Regimen = 10% aminoven
- cc x 10
- 1 gm = 4 kcal

50 gm/d
10% aminoven
500 ml/d
200 kcal/d

6. Glucose solution
- Regimen = 50% glucose
- Kcal = Total Energy requirement (kcal from fat & amino)
- gm/d 3.4 (1 gm = 3.4 kcal)
- cc x 2

50% glucose
1500500200=800 Kcal
235 gm/d
470 ml

7. Electrolyte requirement (maintenance dose)

- 3%NaCl (Mmole x 2 = ml)
20 Mmole = 40 ml
- KCL (Mmole / 2= ml)
20 Mmole = 10 ml
- 50%MgSO4 (Mmole / 2 = ml)
4 Mmole = 2 ml
- K2PO4 (Mmole / 2 = ml)
5 Mmole = 10 ml
(K2PO4 1 ml K 1 Mmole K = 20 + 10 = 30 Mmole)
- 10% ca glu (Mmole x 4 = ml)
1.25 Mmole = 5 ml
- OMVI
4 ml
- Addamel-N
10 ml

81 ml
8. TPN volume fat

500 + 470 + 81 = 1051 ml

9. Total volume

1051 + 250 = 1301 ml

- Fluid (BW 50 kg fluid 2100 ml)

- TPN volume fat
- Total volume

add SW 800 ml
1851 ml
2101 ml

10. order
- TPN volume fat / 24 hr = ml/hr
- 20% intralipid

1851 / 24 = 77 ml/hr
250 ml iv drip in 12 hr

11. NPC : N2 (kcal : g) 100 150 kcal/gm of N2

- amino (gm) / 6.25 = N2 (gm)
- Non protein calories
- NPC : N2 (kcal : g)

50 / 6.25 = 8 gm N2
500 + 800 = 1300 kcal
1300 / 8 = 162 kcal/gm of N2

12. check BUN, cr, elyte, ca, po, mg, alb, TGA /day