Sample Calculation for Enteral Nutrition

Sample Calculation for Enteral Nutrition (EN)

Patient Overview

• Patient's Condition: Patient J.D. is NPO (nothing by mouth) due to dysphagia.

  • Estimated Needs:

  • Energy Needs: 1800-2160 kcal/day

  • Protein Needs: 72-108 g protein/day

  • Fluid Needs: 1.8-2.2 L of fluid daily

• Initial IV Fluid (IVF): IVF will be discontinued once the patient reaches the goal tube feeding (TF) rate.

• Recommended Tube Feeding Formula: Jevity 1.5.

Goal Enteral Regimen Calculation

• Feeding Method: Patient has a PEG tube in place and will start with continuous feeding while in the neuro unit.

Jevity 1.5 Nutritional Composition

• Caloric Density: 1.5 kcals/mL

• Protein Content: 63.8 grams of protein per liter

• Water Content: 76% free water

• Micronutrient Requirements: Meets or exceeds Recommended Daily Intakes (RDIs) for micronutrients in 1000 mL providing 1200 kcal.

Calculation Steps

1. Calculate Total Volume of Tube Feeding Needed for Energy Needs

   • Energy Target: Average of energy needs: 2000 kcal/day

   • Volume Calculation:
     $<br>ext{Total Formula Volume (mL)} = rac{ ext{Energy Needs (kcal/day)}}{ ext{Caloric Density (kcal/mL)}} = rac{2000 ext{ kcal}}{1.5 ext{ kcal/mL}} = 1333 ext{ mL}<br>$

2. Determine Hourly Rate for Continuous Feeding

   • Hourly Rate Calculation:
     $<br>ext{Hourly Rate (mL/h)} = rac{ ext{Total Formula Volume (mL)}}{24} = rac{1333 ext{ mL}}{24 ext{ h}} <br>ightarrow ext{approximately } 55.5 ext{ mL/h}<br>$

   • Rounding Rule: Rates are whole numbers, typically rounded to the nearest 0 or 5

     • Final Rate: 55 mL/h

3. Recalculate Total Volume Based on Rounding

   • Total Volume Calculation:
     $<br>ext{Total Volume (mL)} = ext{Hourly Rate (mL/h)} imes 24 = 55 ext{ mL/h} imes 24 ext{ h}= 1320 ext{ mL}<br>$

Assessing Nutritional Content of the Goal Rate

• Total Formula Provided at Goal Rate: 1320 mL

  • Calories Provided:
    $<br>ext{Total kcal} = ext{Total mL} imes ext{Caloric Density} = 1320 ext{ mL} imes 1.5 ext{ kcal/mL} = 1980 ext{ kcal}<br>$

  • Protein Provided:
    $<br>ext{Total Protein} = ext{Total Volume (L)} imes ext{Protein per L} = 1.32 ext{ L} imes 63.8 ext{ g/L} = 84 ext{ g protein}<br>$

  • Fluid Provided (Free Water):
    $<br>ext{Total Free Water (mL)} = ext{Total mL} imes 0.76 = 1320 ext{ mL} imes 0.76 = 1003 ext{ mL}<br>$

1. Determine Fluid Gap

   • Fluid Target: 2000 mL/day

   • Fluid Gap Calculation:
     $<br>ext{Fluid Gap (mL)} = ext{Fluid Target} - ext{Free Water Provided} = 2000 ext{ mL} - 1003 ext{ mL} = 997 ext{ mL} <br>ightarrow ext{Rounded to } 1000 ext{ mL}<br>$

   • Administration of Water Flushes: Given every 4 hours
     during continuous feeding.

   • Flush Calculation:
     $<br>ext{Flush Volume (mL)} = rac{1000}{6} ext{ (q4h flushes)} = 170 ext{ mL every 4 hours}<br>$

Feeding Orders

• Initial Rate: Start Jevity 1.5 at 20 mL per hour.

• Advancement: Increase by 20 mL every 8 hours as tolerated until reaching the goal rate of 55 mL/h.

• Water Flush Orders: Flush 170 mL water every 4 hours to meet fluid needs.

Summary of Enteral Feeding at Goal Rate

• Total TF Volume: 1320 mL

• Total Calories: 1980 kcal

• Total Protein: 84 g

• Total Free Water: 1003 mL

• Total Fluid with Water Flushes:

  • Initial Water Total: 1003 mL

  • Additional Water from Flushes: 1000 mL

  • Total Fluid: 2020 mL/day

• Conclusion: The TF regimen at goal meets 100% of estimated energy, protein, and fluid needs.

Transition to Bolus Feeding

• Current Status: J.D. is now at goal TF and ready for discharge.

  • Transition Plan: Change to bolus feeding regimen while continuing on Jevity 1.5.

  • Volume Calculation for Bolus Feeding: 1 carton of Jevity 1.5 equals 237 mL.

  • Determine Daily Cartons Required:
    $<br>ext{Cartons Needed} = rac{ ext{Total Volume Needed (mL)}}{ ext{Volume per Carton (mL)}} = rac{1333 ext{ mL}}{237 ext{ mL}} = 5.6 ext{ cartons}<br>$

  • Rounding: Round to nearest carton = 6 cartons/day.

Assessing Nutritional Content for Bolus Regimen

• Total Volume Provided (mL): 6 cartons

  • Total TF Volume Calculation:
    $<br>6 ext{ cartons} imes 237 ext{ mL/carton} = 1422 ext{ mL}<br>$

  • Calories Calculation:
    $<br>1422 ext{ mL} imes 1.5 ext{ kcal/mL} = 2133 ext{ kcal} <br>ightarrow ext{meets energy needs}<br>$

  • Protein Calculation:
    $<br>1.422 ext{ L} imes 63.8 ext{ g/L} = 90 ext{ g protein}<br>$

  • Free Water Calculation:
    $<br>1422 ext{ mL} imes 0.76 = 1080 ext{ mL free water} <br>ightarrow ext{does not meet needs}<br>$

Fluid Gap for Bolus Feeding

• Determine Fluid Gap:

  • Fluid Needs: 2000 mL/day

  • Fluid Gap Calculation:
    $<br>ext{Fluid Gap} = 2000 ext{ mL} - 1080 ext{ mL} = 920 ext{ mL}<br>$

Administration of Water Flushes with Bolus Feeding

• Typical Flushes: Flush 60 mL before and after each bolus.

• Number of Feedings per Day: Plan for 6 feedings.

  • Total Flush for 6 Feedings:
    $<br>ext{Total Flush Volume} = 6 ext{ feedings} imes 120 ext{ mL} = 720 ext{ mL}<br>$

  • Additional Water: Single additional flush = 200 mL daily.

Final Bolus Feeding Orders

• Initiate Bolus Feeding: Start with ½ carton for the first scheduled bolus.

• Advance Feeding: If tolerated, proceed to 1 carton each subsequent feeding.

• Scheduled Feeding Times: Bolus canned Jevity 1.5 at:

  • 7 am

  • 10 am

  • 1 pm

  • 4 pm

  • 7 pm

  • 10 pm daily.

• Flushes: 60 mL before and after bolus + an additional 200 mL once daily between morning bolus due to the fluid gap.

Nutritional Summary for Bolus Feeding

• Total Volume at Goal: 1422 mL (6 cartons)

• Total Calories: 2130 kcal

• Total Protein: 90 g

• Total Free Water: 1080 mL

• Total Fluid with Flushes:

  • Water from Flushes: 920 mL

  • Total Fluid for the Day: 2000 mL/day

• Conclusion: Bolus feeding regimen meets 100% of estimated energy, protein, and fluid requirements for patient J.D.