Nutrition Calculations

Daily fluid need formula (mL/day)

When weight >20 kg: 1,500 mL + (20 mL)(weight in kg - 20)

How can you estimate the fluid needs?

30-40 mL/kg/day

Total energy expenditure (TEE)

BEE x activity factor x stress factor

Activity factors

• 1.2 = non-ambulatory

• 1.3 = ambulatory

Enteral nutrition calories

• Carbs/protein: 4 kcal/g

• Fat: 9 kcal/g

Parenteral nutrition calories

• Dextrose monohydrate: 3.4 kcal/g

• Amino acid solutions: 4 kcal/g

• ILE 10%: 1.1 kcal/mL

• ILE 20%: 2 kcal/mL

• ILE 30%: 3 kcal/mL

Nitrogen (g) =

Protein (g) / 6.25

Corrected Ca (mg/dL) =

Serum Ca (reported) + [(4-albumin) x (0.8)]

Ways to reduce calcium/phosphate precipitate

• Use calcium gluconate

• Add phosphate first

• The 2 should not exceed 45 mEq/L

• Maintain proper pH & refrigerate

What trace elements should be withheld in severe liver disease?

• Manganese

• Copper

What trace elements should be withheld in severe renal disease?

• Selenium

• Chromium

• Molybdenum

What is not routinely given in PN?

Iron

A tube that goes from the nose to the stomach

Nasogastric (NG) tube

A tube that goes through the skin into the stomach

Gastrostomy (PEG or G) tube

A tube that goes into the small intestine

Jejunostomy (PEJ or J) tube

In general, what types of drugs should NOT be crushed and administered via feeding tube?

• Enteric-coated

• Extended- or delayed-release

• Sublingual or buccal

• Hazardous drugs

In general, how can you prevent drug/EN interactions?

Hold the feedings 1 hr before and 1-2 hrs after drug administration

Warfarin EN interaction

• Low INR

• Hold tube feeds 1 hr before and 1 hr after

Tetracycline, quinolones, and levothyroxine EN interaction

• Chelate w/ polyvalent cations

• Separate from tube feeds

Ciprofloxacin EN interaction

• Suspension adheres to tube

• IR tablets: crush and mix

• Flush line before and after

Phenytoin EN interaction

• Binds to feeding solution

• Separate feeds by 2 hrs