University:
Creighton University
Course:
NUR 357 | Professional Concepts II
Academic year:

2022
Views:

345

Pages:

3
Author:

Ean Mason

Almost everything in a neonatal intensive care unit (NICU) is dosed on a per kilogram basis. This includes nutrition. Milliliters of fluid, calories, grams of protein and lipids and mEq of electrolytes are calculated based on the infant’s weight. And, because premature infants rarely receive 250, 500, or 1000 mL day of TPN all of the additives must be calculated. Below is an example: An infant in the NICU, who weighs 1.2 kg, is to receive 130 mL/kg/day of TPN (This does not include lipids). The attending physician asks for the following TPN order to provide 130 mL/kg/day: Dextrose Trophamine 12.5% 2.5 g/kg/day NaCl Na Acetate K Phos Ca Gluc Mag Sulfate Multitrace Multivitamin 2 mEq/kg/day 2 mEq/kg/day 2 mEq/kg/day 3 mEq/kg/day 0.3 mEq/kg/day 0.3 mL/kg/day 1.5 mL/day (This is not ordered per kg) Intralipid 3 g/kg/day You might see other additives in practice, but anything ordered on a per kg basis would be calculated the same. A The first calculation is the rate: 1.2 kg x 130 mL/kg/day = 156 ml/day 156 mL/day x 1 day/24 hours = 6.5 mL/hour B Dextrose is ordered as a percentage and I will show nutritional calculations later. C Protein is calculated based on grams/kg/day which must be converted to a percentage for the TPN order. This 1.2 kg infant is to receive 2.5 g/kg/day of Trophamine (protein) in the 156 mL TPN bag. 2.5 g/kg/day x 1.2 kg = 3 g/day 3 g/day/156 ml = 1.9% (This might be rounded to 2%) D I will show a calculation for one electrolyte, but the calculation is the same for all electrolytes and additives that are ordered per kilogram NaCl 3 mEq/kg/day 3 mEq/kg/day x 1.2 kg = 3.6 mEq/day 3.6 mEq/156 mL = X mEq/1000 mL X = 23.08, This would be rounded to 23 mEq/L E Lipids are ordered at 3 g/kg/day and 20% Intralipid is used. 3 g/kg/day x 1.2 kg = 3.6 g 3.6 g x 100 ml/20 g = 18 ml 18 mL/24 hours = 0.75 mL/hr Nutritional Calculations Calories/kg/day from dextrose (D10 provides 0.34 cal/mL) F D12.5 provides 0.425 cal/mL 156 mL/day x 0.425 cal/mL = 66.3 cal/day 66.3 cal/day/1.2 kg = 55.25 cal/kg/day G Glucose infusion rate (GIR) mg/kg/min GIR H (Dextrose %) x (Rate, mL/hour) = 12.5 X 6.5 = 11.3 mg/kg/min 6 x Wt (kg) 6 x 1.2 kg Calories/kg/day from Lipids 20% Intralipid provides 2 calories/mL 18 mL/day x 2 cal/mL = 36 cal/day 36 cal/day/1.2 kg = 30 cal/kg/day You may also need to calculate calories/kg/day, grams/kg/day, mEq/kg/day from information on a TPN label. TPN to run at 6.8 ml/hour (163.2 mL/day) for a 1.1 kg infant D13% Trophamine 1.8% NaCl Na Acetate K Phos Ca Gluc Mag Sulfate Multitrace 20 mEq/L 15 mEq/L 25 mEq/L 25 mEq/L 2.2 mEq/L 2 mL/L Intralipid 20% to run at 0.7 mL/hr for 24 hours I How many g/kg/day of protein is the infant receiving? 1.8% = 1.8 g/100 mL 1.8 g/100 mL x 163.2 mL/day = 2.94 g/day 2.94 g/day/1.1 kg = 2.67 g/kg/day J How many g/kg/day of lipids is the infant receiving? 0.7 mL/hr x 24 hours/day = 16.8 mL/day 16.8 mL/day x 20 g/100 mL = 3.36 g/day 3.36 g/day/1.1 kg = 3.05 g/kg/day K How many mEq/kg/day of NaCl is the infant receiving? 20 mEq/L x 163.2 mL/day = 3.26 mEq/day 3.26 mEq/day/1.1 kg = 2.97 mEq/kg/day