computerized order sheets
for initiating TPN. First-time users please read through these
instructions in full before using the calculator.
Enter age in months or years
Enter weight in kg.
Enter length or height.
BMI is automatically calculated. If
BMI > 95%, then consider potential confounding factors:
edema, ascites, altered body composition. If present,
make calculations using ideal body weight (IBW).
Enter stress factor consideration. Most patients receiving
PN require no adjustment.
The first 'Calculate' sequence will automatically provide
the predicted REE, adjusted REE, and TDEE. In addition, the
expected fluid requirement will be determined. These values
can be altered to meet special requirements.
Pick the route of infusion as 'Central' or 'Peripheral'.
Determine the desired amount of 20% IL to infuse daily.
The calculator automatically subtracts this energy infusion
and fluid amount from the totals required.
The second 'Calculate' will now use the remaining fluid, the
remaining calories, and the known amino acid requirment for
age to calculate the needed dextrose concentration, amino
acid concentration, and infusion rates.
These values will appear in appropriate boxes along with a
determination of total calories compared to the estimated
needs. Dextrose concentrations are rounded to the closest
2.5%. Amino acid concentrations are rounded to the nearest
Default values for electrolyte and mineral requirements lead
to automatic assignment of concentrations within the desired
amount of fluid. Alterations in electrolyte per kg can be
made. Re-calculation of concentration will follow.
Changes in cc/day, cc/kg/day, kcal/kg/day, and IL gm/kg/day
will produce re-calculation of PN constituent concentrations and rates.
Note if standard vitamin and trace element additives are
Review if special circumstances exist for fluid replacement.
Enter supplemental fluid type and rate.
Decide if any medications are necessary. Click and
quantitate heparin or famotidine. Add other medications.
- follow clinical appearance of the child, particularly state of hydration and level of consciousness
- review daily the typed label on the PN solution to assure that actual consituents match those desired
- daily weight
- in infants, measure length weekly. Measure OFC monthly
Many TPN protocols call for periodic
measurement of multiple laboratory values. Experience
indicates, however, that significant clinical problems are
most effectively identified by careful review of patient
status rather than by structured routine laboratory testing.
Such testing often reveals inconsequential deviations from
laboratory normals that do not affect the patient course.
Particular attention to individual conditions that
predispose to laboratory abnormalities is more efficient and
useful. In addition, patients receiving TPN are ill with
additional problems. Those problems usually mandate
measurement of lab values that would be considered routine.
Please refer to specific clinical situations outlined in the