Name

Pre Lecture PN Calculations & Complications – 20 points

Ted is a 48 y.o. male admitted to the surgical floor for an exacerbation of Crohn’s disease (severe
inflammation of the small bowel usually but can affect the GI tract anywhere). He is currently NPO and
will be starting PN before being discharged in a few days. He will be on PN for 6-8 weeks due to the
presence of a high output fistula. A PN consult has been ordered and he will begin PN today which is
hospital day #4. An implantable device has been placed for vascular access. MIV @ 130 mL/hr with ½
normal saline & 20 mEq KCl/d. He has been NPO since admit.

Ht: 5’ 10” Current Wt: 170 lbs. UBW: 175 lbs. (3 weeks ago)
Meds: antibiotics

HOD 1 2 3 4
Weight: 77 kg 74 kg 75 76
Labs:
Sodium 138 140 142 143
Potassium 4.0 4.1 4.0 3.5
Chloride 107 108 108 110
HCO2 26 25 24 22
Glucose 91 120 125 122
BUN 10 9 9.5 8
Creatinine 0.8 0.8 0.7 0.8
Prealbumin (16- 10 8
40)
Albumin 2.8 2.7
Phosphorus (2.5- 2.2
4.5)
Magnesium (1.5- 1.3
2.5)
Triglycerides 155
Total Bilirubin 0.1 0.2
(0.1-1.0)
AST (7-55) 33 37
ALT (8-48) 40 42
WBC 11 11.5 11.5 13
Hemoglobin 12.5 12.5 12 11.9
Temperature 38.6 38 39 39
(centigrade)
Input/Output: 3500 mL 3500 mL 3560 mL 3500 mL

Urine 2000 mL 2500 mL 2620 mL 2500 mL

Stools None None smear Smear
Fistula ~500mL ~550 mL 550 mL 525 mL

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Create a Nutrition Prescription (3 points):
Calories: 35kcal x 77kg= 2695 kcal/day
Protein: 1.7g x 77kg= 131g/d
Fluid:30ml x 77kg= 2310mL/d

Calculate the following (6 points):

Dextrose needed in grams: 1521/3.4=447
Amino acids needed in grams: 131 x 4= 524kcal (2700-524=2176)
Lipids needed in grams: 2176 x .3= 652.8 /10 = 65.5

List the most common complications associated with PN (at least 5) 5 points:

 Immune function
 gallbladder contraction
 catheter related infections
 hyperglycemia
 blood stream infections

Complete the following PN order for PN day 1 based on Ted’s laboratory data for hospital day #4
highlighted in yellow exhibited above; show your work for how you calculated his goal rate (6 points):

Dextrose 70%
445g/x=700/1000
700x=445000
Dextrose=636mL
Amino acids 10%
131/x=100/1000
100x=131000
Amino acids=1310mL
Lipids 20%
330mL
636+1310+330=2276mL. +150=2426/24=. 101mL/hr

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 TNA Day # 1 Weight used for calculations: __77___ kg

All additives are based on AMOUNT PER DAY:

Dextrose grams  TNA Sliding Scale Regular Insulin – check b
Amino acids grams (FSBS (Finger-stick blood sugar) every 6 hours)
Lipids grams
Sodium Chloride 100 mEq FSBS Regular Insulin sub
Sodium Acetate 60 mEq Less than 70mg/dL Call physician
Sodium Phosphate 0 mEq 140 - 179 mg/dL 3 units
Potassium Chloride 60 mEq 180 - 199 mg/dL 4 units
Potassium Phosphate 20 mEq 200 - 249 mg/dL 6 units
Potassium Acetate 0 mEq 250 - 299 mg/dL 9 units
Magnesium Sulfate 10 mEq 300 - 349 mg/dL 12 units
Calcium Gluconate 10 mEq 350 - 399 mg/dL 15 units
MVI (Adult) 10 mL More than 400mg/dL Call physician
Trace Elements 1 mL
Regular insulin units _______ IV insulin drip @ _____
Famotidine mg
Thiamine mg
Folic Acid mg
Zinc sulfate mg
Vitamin C mg

__x__ Start TNA at __30___mL per hour for _9__ hours and decrease MIV to __100___ mL/hr;
After 8 hours if FSBS < 200 mg/dL, increase TNA to: __60___ mL per hour and decrease MIV rate to: __70___ mL/hr
Then after 8 hours if FSBS < 200 mg/dL, increase TNA to goal rate of __10114___ mL/hr and decrease MIV rate to __40_

Total TNA/ MIV:_____141____ mL/hr

Date for lab draw: ________

____TPN-A labs (CBC with Diff, BMP, Pre-albumin, Mag, Phos, Calcium, Trig, PT/INR)

__x__TPN-B labs (BMP, Mag, Phos, Calcium, Albumin)

__x__Daily weight __x___Daily intake and output Other: ________

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