Universidad Anáhuac Mayab

Facultad de medicina.

Name: Daniel David Jarquín.

ID: 00343233

Subject: Endonutrition
Activity: Parenteral nutrition case.

Dr. Ricardo Veloz

October 2022.
Case:

VC is a Female, 35 years old, a school teacher. No significant health history except for a history of
Chron's disease. While at work, she experiences severe abdominal pain and bloating. Their
coworkers take her to the emergency room. Doctors detect an abdominal obstruction due to scar
tissue from previous surgery. She is administered intravenous fluids and nasogastric decompression;
however, this does not work and on day 3 of hospitalization she undergoes surgery to remove the
scar tissue. 24 hours after surgery, her diet is progressed to clear liquids, but VC cannot tolerate
them and she vomits. After that, a postoperative ileus was diagnosed. Because of it, at the moment,
oral feeding is contraindicated.

Anthropometric data:

Weight: 58 Kg, Height:168 cm, BMI: 20.6 kg/m2

Questions:

1. What would be the recommended access route in this case?

● Parenteral nutrition, in the case are absolute contraindications to EN.

2. Wich kind of infusion rate is the best choice in this case?

● 84.5 ml/hr

3. Determine fluid and energy requirements for the patient:

● Fluid: 35 ml/kg/day= (35)(58)= 2,030 ml/kg

● Energy: 30 Kcal/Kg/day=(30)(58)= 1,740 Kcal/day

4. Calculate the amount of protein and carbohydrate needed (g)

● Protein: 1.5 g/kg/day= (15)(58)= 87 g/day

● Carbohydrate: 3 mg/kg/min= (3)(58)(1,440)= 250,560 mg= 250.5 g
○ 24 hours: 1,440 minutes
○ 1,000: 1 g.

5. Calculate calories provided by protein and carbohydrate (Kcal)

● Each gram of protein provides 4 Kcal.

● Protein: 87 g = 87 x 4 Kcal =348
○ Kcal Dextrose in the parenteral solution provides 3.4 Kcal/g
 ■ Carbohydrates: 250.5g = 250.5g x 3.4 =851.7 Kca

6. Calculate the amount of fat needed (Kcal)

● Total energy= calories from carbohydrate + calories from protein + calories from fat
○ Calories from fat = total energy – (calories from carbohydrate + calories from protein)
○ 1740Kcal/day – (851.7Kcal + 348Kcal) = 541 Kcal

7. Determine which stock solutions/emulsion will be used (%)

● Aminoacid stock solution at 20%

● Carbohydrate stock solution at 70%
● Lipid stock solution at 10%

8. Calculate the volume of each macronutrient (ml)

● 435 ml of aminoacid stock solution 20%

● 370 ml of stock solution at 70%
● 541 ml of stock solution at 10%

9. Calculate the minimum total volume (ml)

● 435 ml + 370 ml + 541ml = 1346 ml

● 1346 + 150 = 1469 ml
● 2030 - 1469 = 534 ml of sterile water

10. Write a prescription for VC.

● Patient VC
● Weight: 58 kg
● Infusion: central
● Volume: 2,300 ml
● Rate: 84.5 ml/hour
○ Amino acids: 87 g/day= 435 ml aa 20%
○ Dextrose: 250.5/day g= 370 ml dextrose 70%
○ Lipids: 54.1 g/day = 541 ml IVFE 20%
○ Water: 534 m