For whichever formula you used in question 28, calculate the ...

[Yolanda]

For whichever formula you used in question 28, calculate the amount of TPN Mrs. M will need daily to meet her energy and protein requirements. Consider the lipids you are giving in your calculations.

Question 2

For TPN, would you use the standard formula or create a new formula? Give reasons for your answer, and regardless of which formula you use, list the constituents and amounts you would recommend be given on a daily basis (assume you are working at a hospital that allows individual formulation of TPN formulas if necessary).

[kxciann]

Answer to Question 1

400 cc of 10 lipids = 440 kcals
1760 - 440 = 1320 kcals to be accounted for
500 cc of 10 AA = 50 g/L
70 g required / 50 = 1.4 L/d
70 g  4 kcals/g = 280 kcals
1320 - 280 = 1040
1.4 L of 25 dextrose = 350 g dextrose  3.4 kcals/g = 1190

This would provide a total caloric intake of 1910 vs. 1760 calculated or 150 additional kcals. This is about as good as can be done with standard TPN.

Answer to Question 2

Allowing for individual formulation, I would use 30 of the kcals from lipids, 70 g of protein from a 10 solution, and the remaining kcals to come from CHO. The concentration of the CHO would vary from patient to patient to meet the final caloric requirements. Standard electrolytes, vitamins and minerals should be added each day.

From question 16 (from Part I of this case study), as an example use a BEE of 1760 kcals (stress factor of 1.6) and 70 g of protein (stress factor of 1.6). The amount of TPN used by your students will depend on the method of calculation you taught in class. The answer will also depend on whether or not you are using three-in-one mixtures, piggy-back, etc. These options are up to the instructor.

Example: Using the caloric and protein estimations above with a formula of 500 cc D50 and 500 cc of an amino acid mixture at 10 (I would vary from the 8.5 standard to a 10 solution to use less fluid and thus less dextrose), with 500 cc 10 lipids per day, the following amounts would be used:

400 cc of 10 lipids = 440 kcals
500 cc of 10 AA = 50 g/l
70 g required / 50 g/l = 1.4 l/d

[Yolanda]

Gracias!

[bdobbins]

Excellent