v Ideal Body Weight method

Hammond Equation (Ideal Body weight)

Males= 48+ 1.1 X (Ht-150)

Females= 45 + 0.9 X (Ht-150)

v Evaluating the significance of weight loss

Percent Weight Change= (Usual weight – Actual weight) × 100

Usual weight

Table 1-5

Time interval Significant weight loss (%) Severe weight loss

1 Week 1.0 -2.0 >2.0

1 Month 5.0 >5.0

3 Months 7.5 >7.5

6 Months 10 >10.0

v Percentage of IBW
% IBW=Current body weight (CBW) ×100%
IBW
v Percentage of UBW
% UBW=Current body weight (CBW)×100%
UBW
Table 1-4
Index Mild Deficit% Moderate Deficit% Severe Deficit%
IBW 80-90 70-79 <70
UBW 85-95 75-84 <75

v Adjusted body weight (AdjBW) equation:

AdjBW = 0.25 (ABW-IBW) + IBW
Where: ABW = actual body weight; IBW =ideal body weight

This equation is used when patients are more than 125 % of IBW,
 v Evaluating the significance of weight loss
Percent Weight Change= (Usual weight – Actual weight) × 100

Usual weight

Table 1-5

Time interval Significant weight loss (%) Severe weight loss

1 Week 1.0 -2.0 >2.0

1 Month 5.0 >5.0

3 Months 7.5 >7.5

6 Months 10 >10.0

v Estimating Caloric Needs:

NOTE: For calculation requirement:

• For Normal body weight use Actual body weight

• For Underweight /overweight use Ideal body weight
• For Obese use Adjusted Body Weight

1. Harris- Benedict Equation:

Use This Equation For: Under weight, ICU and Diabetic Patients.

Men: BEE= 66.47 + (13.75 × wt. in Kg) + (5.0 × ht. in cm) - (6.76 × age in yrs)

Woman: BEE = 655.10 + (9.56× wt. in kg) + (1.85 × ht. in cm) – (4.68× age in yrs)

Total Kilocalorie Requirements= BEE× Activity factor × Injury factor.

Table 2-1 Activity Factors :

Confined to bed 1.2

Out of bed 1.3

Seated work, little movement 1.4- 1.5

Standing work 1.8- 1.9

Strenuous work or highly active 2.0 – 2.4

Table 2-2 Injury Factors:

Blunt Trauma 1.25 - 1.50

Burn (% total body surface):
0-20 1.0 - 1.50
20-40 1.5 - 1.85
40-100 1.85 - 2.05
Cancer 1.1 - 1.45
Closed Head Injury 1.3
Elective Surgery 1.0 - 1.1
Fever 1.2 per 1°c > 37 °c
Post Operative (no complication) 1.0 - 1.05
Multiple / Long Bone Fracture 1.1 - 1.3
Multiple Trauma with Patient on Ventilator 1.50 - 1.70
Multiple Trauma 1.4
Peritonitis 1.05 - 1.25
Sepsis 1.2 - 1.4
Sever Infection/ Multiple Trauma 1.3 - 1.55
Trauma with Steroids 1.60 - 1.70
Wound Healing 1.20 - 1.60

2. Short Cut Method for Estimating Adult Energy Needs per

Kilogram:
1. Table 2-3

Conditions Kcals Required

Non Obese Population 25-35 kcal/ kg /day

Hypermetabolic 30-35 kcal/kg /day

 Obese, Critically Ill Population 22 kcal/ kg /day

Paraplegics 28 kcal / kg /day

Quadriplegics 23 kcal/ kg / day

v Estimation of Protein RDA

Table 2-4 Protein Requirements based on albumin level:

Condition Albumin Level Protein Requirement

Normal Nutrition (Healthy Adult) >3.5 gm/ dl 0.8 gm /kg /day

Normal Nutrition (Elderly Adult) >3.5 gm /dl 0.8 - 1.0 gm/kg/day

Mild Depletion 2.8-3.5 gm / dl 1.0 - 1.2 gm /kg /day

Moderate Depletion 2.1- 2.7 gm /dl 1.2 - 1.5 gm/ kg /day

Severe Depletion <2.1 gm /dl 1.5 - 2.0 gm / kg/day

Table 2-5 Protein Requirements for Specific Conditions: (2)

Condition Protein Requirement

Cancer 1-1.5 gm/kg
Cancer Cachexia 1.5-2.5 gm/kg
Bone Marrow Transplant 1.5 gm/kg
Inflammatory Bowel Disease 1-1.5 g/kg
Short Bowel Syndrome 1.5-2 g/kg
BMI>27, Normal Renal & Hepatic Function 1.5 -2 gm/kg/ideal body weight/d

Obesity class I or II, Trauma (ICU) (with hypocaloric feeding)

1.9gm/kg/IBW/D
Obesity class III, Trauma(ICU) 2.5 gm/kg/IBW/D
Pregnancy (with
+25gmhypocaloric feeding )
Pulmonary Disease (with hypocaloric
1.2-1.5 g/kg feeding )
Burn, sepsis, Traumatic, Brain injury 1.5-2 gm/kg or 100 - 125 gm protein /day
Stroke 1-1.25gm/kg

Table 2-6 Protein Requirements for Surgical Patients :

 Stress Level Condition Protein

Normal Healthy 0.8

Mild Minor surgery, mild infection 0.8-1.2

Moderate Major surgery, moderate infection, 1.2-1.8

moderate skeletal trauma

Severe Severe infection, multiple injuries, 1.6-2.2

sever trauma, major burns

v Estimating Fluid Requirements

Method 1: 1ml/kcal

Method 2

• For the first 10 kg of body weight, give 100 ml/kg per day

• For the second 10 kg of body weight, add 50 ml/kg per day

• For each additional kg of body weight, add 20 ml/kg per day if 50 years of age or
less, or add 15 ml/kg per day if older than 50.

Table 2-7

Body Weight Fluid Requirement

≤10 kg 100ml/kg
11-20 kg 1000ml +50 ml /kg for each kg >10kg
>20 kg 1500ml +20ml/kg for each kg> 20kg

Method 3

• For young, vigorous, previously healthy adults (<18 years),40ml/kg

• For other adults (18-55 years),35ml/kg

• For elderly adults(> 55 years),30 ml/kg