RK is a 154 lb female with Hyperemesis Gravidarum [average daily emesis = 750ml]
ID: 242941 • Letter: R
Question
RK is a 154 lb female with Hyperemesis Gravidarum [average daily emesis = 750ml] who has been ordered the following:
TPN @ 25Kcal/kg: 30% Kcal from Lipids, 1gm/kg from amino acids and the balance of calories from dextrose.
How would the pharmacist design the above TPN using 10% amino acids, 50% dextrose, 20% lipids and sterile water for injection? Using standards of care for pregnant patients [per Practical Gastroenterology-June 2008], fluid requirements during pregnancy are 30ml/kg plus an additional volume to replace that which is lost daily via emesis.
1. Calculate the maximum daily fluid requirements _______________________________________
2. Calculate total Kcal ____________________________________________
3. Calculate Kcal from lipids __________________________________________ a. Calculate the volume of lipids ________________________________________ b. Calculate the grams of lipids ________________________________________
4. Calculate the grams of amino acids per day _______________________________ a. Calculate the volume of amino acids _______________________________ b. Calculate the Kcal of amino acids __________________________________
5. Calculate the Kcal from dextrose ____________________________________________ a. Calculate the grams of dextrose per day ____________________________________ b. Calculate the volume of dextrose per day ____________________________________
6. Calculate volume of sterile water to “qs” to total daily fluid requirements __________________________________________
7. Calculate the infusion rate (in ml/hr) if the TPN is to be infused over 24 hours ___________________________________________
Explanation / Answer
1lbs = 0.45 kg
154 lbs = 69.3 kg
1. Daily fluid requirement is 30 ml/kg + 750 ml (emisis loss)
So, 30*69.3 =2079+750 = 2829 ml
2. total calorie = 25kcal per kg = 25*69.3 =1732.5 kcal
3. calories from Lipids = 30% from lipid
total calories * 30/100= 1732.5*30/100 =519.75kcal
a, Volume of lipid = 20% of total solution= 2829*20/100=565.8ml
b grams of lipid = 30% of lipid in 565.8 ml =30*565.8/100 =169.74 gram
4. grams of amino acid per day
1 gm per kg = 1*69.3 = 69.3 gms of amino acid
a. volume of amino acid
b. calories of amino acid
4kcal/gm
69.3*4=277.2 kcal
5. calories from dextrose= total calories- amino acid calories-lipid calories
1732.5kcal-519.75kcal-277.2 kcal=935.55 kcal
a. Total kcal/3.4 kcal/gm= 935.55/3.4 kcal/gm=275.2 gms
b.
6.
7.infusion rate over 24 hrs= total volume/ 24 hr = 2829ml/24hrs =118 ml/hr
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