Metabolic nutrition calc, Cheat Sheet of Metabolic Nutrition

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Parenteral Nutrition Formula

Calculations and Monitoring Protocols

Macronutrient Concentrations in PN Solutions

Macronutrient concentrations (%) = the grams of solute/100 ml of fluid

D70 has 70 grams of dextrose per 100 ml.

10% amino acid solution has 10 grams amino acids/100 ml of solution

20% lipids has 20 grams of lipid/100 ml of solution

Calculation of Dextrose Calories

Calculate grams of dextrose:

• (^) Multiply the total volume of dextrose soln (in ml) supplied in a day by the dextrose concentration. This gives you grams of dextrose supplied in a day.

Multiply the grams of dextrose by 3.4 (there are 3.4 kcal/g dextrose) to determine kcalories supplied by dextrose in a day.

Sample Dextrose Calculation

1000 ml of D50W (50% dextrose)

• (^) 1000 ml x 50g / 100 ml = 500g dextrose
• (^) OR 1000 ml x .50 = 500g dextrose

500g dextrose x 3.4 kcal/g = 1700 kcal

Example Lipid Calculation for 2-in-

500 ml of 10% lipid

• (^) 500 ml x 1.1 kcal/ml = 550 kcal

500 ml 20% lipid

• (^) 500 ml x 2.0 kcal/ml = 1000 kcal

Or, alternatively, 500 ml of 10% lipid = 50 grams lipid x 10 kcal/g or 500 kcal Source: http://www.csun.edu/~cjh78264/parenteral/calculation/calc07.html

Calculation of Dextrose/AA with Piggyback Lipids (2-in-1)  (^) Determine patient's kcalorie, protein, and fluid needs.  (^) Determine lipid volume and rate for "piggy back" administration.

• (^) Determine kcals to be supplied from lipid. (Usually 30% of total kcals).
• (^) Divide lipid kcals by 1.1 kcal/cc if you are using 10% lipids; divide lipid kcals by 2 kcal/cc if you are using 20% lipids. This is the total volume.
• (^) Divide total volume of lipid by 24 hr to determine rate in cc/hr. Source: http://www.csun.edu/~cjh78264/parenteral/calculation/calc07.html

Determine dextrose concentration.  (^) Subtract kcals of lipid + calories from protein from total kcals to determine remaining kcal needs.  (^) Divide "remaining kcals" by 3.4 kcal/g to determine grams of dextrose.  (^) Divide dextrose grams by remaining fluid needs (in protein calculations) and multiply by 100 to determine dextrose concentration.  (^) Determine rate of AA/dex solution by dividing "remaining fluid needs” by 24 hr. Source: http://www.csun.edu/~cjh78264/parenteral/calculation/calc07.html

Example Calculation

Nutrient Needs: Kcals: 1800. Protein: 88 g. Fluid: 2000 cc 1800 kcal x 30% = 540 kcal from lipid Lipid (10%):

• (^) 540 kcal/1.1 (kcal/cc) = 491 cc/24 hr = 20 cc/hr 10% lipid (round to 480 ml)  Remaining fluid needs: 2000cc - 480cc = 1520cc

Dextrose Concentration



920 kcal/3.4 kcal/g = 270 g dextrose



270 g / 1520 cc x 100 = 17.7%

dextrose solution



Rate of Amino Acid / Dextrose: 1520

cc / 24hr = 63 cc/hr

TPN recommendation: Suggest two-in-one PN 17.7% dextrose, 5.8% a.a. @ 63 cc/hr with 10% lipids piggyback @ 20 cc/hr

Re-check calculations

TPN recommendation: Suggest two-in-one PN 17.7% dextrose, 5.8% a.a. @ 63 cc/hr with 10% lipids piggyback @ 20 cc/hr 63 cc/hr x 24 = 1512 ml 1512 * (.177) = 268 g D X 3.4 kcals= 911 kcals 1512 * (.058) = 88 g a.a. x 4 kcals = 352 20 cc/hr lipids24 = 4801.1 kcals/cc = 528 1791

3-in-1 TNA Solutions

 (^) Determine protein concentration by dividing protein needs (grams) by total daily volume and multiply by 100.  (^) Multiply protein needs in grams x 4 kcal/gm = kcals from protein  (^) Determine dextrose grams.  (^) Subtract kcals of lipid and kcals from protein from total kcals to determine remaining kcal needs.  (^) Divide "remaining kcals" by 3.4 kcal/g to determine grams of dextrose.  (^) Determine dextrose concentration by dividing dextrose grams by total daily volume and multiply by 100

Sample Calculation 3-in-

 Nutrient Needs:

• (^) Kcals: 1800 Protein: 88 g Fluid: 2000 cc  (^) Lipid : 1800 kcal x 30% = 540 kcal
• (^) 540 kcal / 10 kcal per gram = 54 g
• (^) 54 g / 2000 cc x 100 = 2.7% lipid  (^) Protein: 88 g / 2000 cc x 100 = 4.4% amino acids  88 g x 4 = 352 kcals from protein

Evaluation of a TNA Order

PN 15% dextrose, 4.5% a.a., 3% lipid @ 100 cc/hour

Evaluation of a PN Order

PN 15% dextrose, 4.5% a.a., 3% lipid @ 100 cc/hour

Total volume = 2400

Dextrose: 15g/100 ml * 2400 ml = 360 g

360 g x 3.4 kcal/gram = 1224 kcals

Lipids 3 g/100 ml x 2400 ml = 72 g lipids

72 x 10 kcals/gram = 720 kcals