MNT Exam 1: PN recipe

• There are 10 steps
• You need to have calcuated energy needs, protein needs, and fluid needs (if not given)

Determine total volume and infusion rate

Fluid need = kg x 30-35 cc/hr (can do 30 cc/hr with this)

Infusion rate ex: 1890 ml/24 hrs = 79 ml = 80 ml/hr (round!)

Total fluid need ex: 80 ml x 24 hrs = 1896 ml/day

determine calories from fat

20-30% kcal from fat

ex: 1476 kcal (from patient tee) x 25% kcal lipid = 369 kcal from fat

Choose from the 4 options for lipid bags

• Either: 250 ml of 10% (250 kcal)
• 250 ml of 20% (500 kcal)
• 500 ml of 10% (500 kcal)
• 500 ml of 20% ( 1000kcal)

Ex: we choose 500 ml of 10% lipid to provide 500 kcal

determine remaining calorie and fluid needs

ex kcals: 1476 kcal- 500 kcal fat = 976 kcal

fluid: 1896 total ml- 500 ml from fat = 1396 ml

AA % concentration to meet protein need

ex: (44 g total /1396ml remain fluid) x 100 = 3.15 = 3% (dont forget to round)

determine calories from protein

ex: 3 % aa x 1396 ml remaining = 42 g aa

42 g aa x 4 kcal/kg (std amt)= 168 kcal

Determine % CHO/dextrose from remaining kcal

ex remaining: 1476 kcal (total)- 500 kcal fat- 168 kcal pro = 808 kcal

ex: 808 kcal remain/ 1396 remain fluid = 238 g CHO

ex: (238 g CHO/ 1396 ml remain) x 100 = 17 = 15% dextrose

Determine kcal from dextrose

ex: 15% dextrose x 1396 ml = 209 g CHO

ex: 209 g CHO x 3.4 kcal/g = 711 kcal

Perform a values check

ex: 80 ml/hr of 15% CHO, 3% aa, 500 ml of 10% from fat

Yields 500 kcal from fat + 168 kcal pro + 808 kcal CHO= 1476 kcal total

• 808 kcal CHO / 1476 total kcal = 55 % cal from CHO
• 168 kcal pro/ 1476 total kcal = 11% cal from pro
• 500 kcal pro/ 1476 total kcal = 34% cal from fat

Check FIR and GIR

• ex GIR: (goal less than 5 mg/kg/min)
• 209000 g CHO/ 55 kg = 3800 g CHO/kg

3800 g CHO/kg / 1440 min = 2.64 g/kg/min

• ex FIR: (goal less than 2 mg/kg/min)
• 500 ml x 10% = 50g fat/ 55kg = 0.91 g/kg/min

The nutrition prescription

ex: no electrolyte of vitamin/mineral abnormalities identified, standard doses ok at this time

ex: Initiate TPN with D 15%, AA 3% at 30 ml/hr advancing by 25 ml/hr every 12 hrs to get to goal rate of 80 ml/hr.

Administr 500 ml of 10% lipid at 20 ml/hr

Yields 1896 ml total fluid, 1476 total kcal, 44 g protein, 209 g CHO, 50 g fat,

Include MVI and MTE