Doctorseducation_CPR_PALS_NALS

                            TPN CALCULATIONS
                        MULTIPLICATION FACTOR ( Weight In Kgm multiply by 10 )

Days                  1        2        3         4         5         6        7          8        9         10        11

Total Fluid        6        8       10       12       14       15      15         15     15         15       15 Intake (ml)

10% Cal.        0.8      0.8      0.8      0.8     0.8      0.8      0.8       0.8     0.8       0.8      0.8
Gluconate

10%                   -         -          -          -          -       0.5       1         1.5      2         2.5        3
Intralipid

TPN Vol.        5.2       7.2     9.2    11.2    13.2    13.7    13.2      12.7   12.2     11.7    11.2
Ordered

TPN Vol.       8.2      10.2   12.2   14.2    16.2    16.7    16.2      15.7    15.2     14.7    14.2
Prepared*

5% Amino-      -           -       1.3     2.5      3.7      4.9       6.1       7.4      7.5       7.6     7.6
plasmal-P

Normal             -         2.1      2       1.9      1.7     1.2       0.7        0.5      0.5       0.4     0.4
Saline

15% KCL          -        0.14   0.13    0.13    0.11    0.1     0.08      0.07    0.07     0.07   0.07

50% Mag           -          -       0.04    0.03    0.03    0.03   0.03      0.03    0.03     0.03   0.03
Sulphate

M.V.I.               -          -      0.13     0.13   0.12     0.12   0.12      0.12    0.12    0.12   0.12

10%                   6.8      4.8     4.2        4        4         3.3     1.9          -          -         -          -
Dextrose

25%                   1.4       3.2   4.4       5.5     6.5          7      7.3         7.6       7        6.5      6
Dextrose

     Overfill volume is variable with this calculation ranging from 15-50 ml (app)

                            ADDITION OF FLUIDS

                              (e.g. Phototherapy, warmer etc.)

1. With the increase in the volume of fluid, the ratio of TPN ordered and prepared is increased. It will increase the amount of all the constituents delivered. All of these namely, A.A., Nacl, Kcl, Mag, MVI and Dextrose has to be recalculated by multiplying with the following factor :-

                                  TPN ordered               TPN prepared + Add fluid
Factor     =         -------------------      x      ----------------------------------
                                    TPN prepared              TPN ordered + Add fluid

2. TOTAL AMOUNT OF FLUID TO BE INCREASED

                 Xml. = Additional Fluid + {TPN prepared x (1-factor)}

3. TYPE OF FLUID TO BE INCREASED

If only 10% dextrose is added to make up the additional fluid, then glucose (gm/d and conc.) will increase. Additional fluid is calculated as follow :-

                   ADD Xml. x 1.65 of 10% Dextrose and

                    SUBTRACT Xml. x 0.65of 25% Dextorse.


                      SUBTRACTION OF FLUIDS
                  (e.g. Diluent of Injections , Partial oral feeds, etc.)

1. All the constituents will decrease. Increase the amount of all these by multiplying with the following factor.

                                    TPN ordered              TPN prepared - Extra Fluid
FACTOR      =       -------------------      x      ------------------------------------
                                      TPN prepared             TPN ordered - Extra Fluid

2. TOTAL AMOUNT OF FLUID TO BE DECREASED

                 Xml. = Extra fluid + {TPN prepared x (Factor-1)}

3. TYPE OF FLUID TO BE DECREASED
If only 10% dextrose is decreased then glucose conc. (%) will increase beyond 12.5%. So do it in the following way :-

               SUBTRACT Xml. x 0.8 of 10% dextrose and
                                   Xml. x 0.2 ml. of 25% dextrose.

THESE CALCULATIONS ARE BASED ON THE FOLLOWING RECOMMENDATIONS

AMINOACIDS are started on day 3 (0.5 gm/k/d) and increased by 0.5gm/k/d to max of 3 gm/k/d. 5% AMINOPLASM-P is used which contains 0.5 gm AA/10 ml,
50 meq of Na/L, 25 meq of K/L, 5 meq of Mg/L and 0.2 Cal/ml.
LIPIDS are started on day 6 (0.5 gm/k/d) and increased by 0.5gm/k/d to max of 3gm/k/d. 10% INTRALIPID or 10% LIPOFUNDIN is used which contains
1gm lipid/10 ml and 1.1 Cal/ml.
CARBOHYDRATES are started on day 1(6 mgm/k/min) and increased daily by
2 mgm/k/min to max of 14 mg/k/min (if no hyperglycemia) and upto max of
12.5% solution can be used by mixing 10% dextrose and 25% dextrose.
SODIUM (3-4 meq/k/d) is provided by 5%. Aminoplasm-P (50meq/L)
and normal Saline (154meq/L).
POTASSIUM (2-3 meq/k/d) is provided by 5% Aminoplasm-P (25meq/L)
and 15% KCL (2meq/ml).
TRACE ELEMENTS : ( Zn, Cu, Mn, Se ) are provided by plasma 10 ml/ kg
every 3rd day.
VITAMIN K : Inj Vitamin K 0.5 - 1 mg is given weekly .
INJECTION VITCOFOL provides 5 ug VITAMIN B12 and 500 ug Folic Acid .
MAGNESIUM is provided by 50% MgSO4 ( 1meq/k/d ).
MVI (1ml/k/d) is also added.

        ACTUAL AMOUNT DELIVERED BY THIS CALCULATION

This chart shows the actual amount of fluid / conc you will be delivering to the patient .The    concenteration of many constituents changes because you prepare the volume in excess of what is required .This ready reference will help in changing the required constituents according to your specific situation.
Glucose (concentration and mg/k/min) can be altered by changing amount of 10% and 25% dextrose.The glucose conc has been maintained with 10% and 25% solution only because 50% solution is not readily availabe in all over india. That is why from 8th day onwardds the concenteration of glucose remains below 12.5% ( 12.1,11.5,11,10.5 ) inspite of adding only 25% dextrose solution. this can be altered and made more concenterate by adding 50% solution of dextrose if available.

Days                 1           2           3            4            5            6           7            8            9           10          11

Fluid Intake     60        80        100        120        140        150       150        150        150        150       150
ml/K/D

TPN Order       52        72         92         112        132         137      132        127        122        117        112
ml/K/D

TPN Prepare 82       102       122        142        162          167      162        157       152         147        142
ml/K/D

Amino- plasm -           -           9.8         19.7       30            40       49.7        59.8      60.2         60         60
ml/K/D

Sodium             -          2.3         2.8         3.28       3.67        3.5       3.32        3.6        3.6           3.47      3.5
meq/K/D

Potassium        -         1.98         2.2         2.53      2.54        2.64     2.55        2.58       2.62         2.68      2.6
meq/K/D

Dextrose         4.5       6.3           8             9.7       11.4         11.8      11.4       10.7        9.8            9         8.2
mg/K/min

Dextrose       12.5      12.5        12.4        12.5       12.5         12.4      12.4       12.1       11.5         11       10.5
conc. ( % )

       Magnesium and MVI amount is approximately maintained constant.