Question

3. Karol is a 38-year old White female experiencing severe GI complications and intractable N/V/D for the past three weeks post-op. Patient underwent bariatric surgery one month prior to developing these symptoms. Her surgeon orders a nutrition consult for total parenteral nutrition (TPN) orders after recent PICC line placement. Height: 5'6" Weight: 226 lb. UBW: 270 lb. Pertinent Labs: K+ - 3.3; Na - 149; Glucose - 83; Albumin - 2.6 Pertinent Meds: Daily MVI, Aspirin, Vitamin B12, 10,000 mcg daily GI Status: Bowel sounds - absent; abdomen - soft, distended; last BM - diarrhea two days PTA. A. What is her BMI and interpretation? B. Calculate her IBW, %UBW, and % weight change. C. Calculate her estimated energy, protein, and fluid needs. D. Construct two PES statements for this case. E. Calculate estimated energy recommendations and a corresponding initial TPN goal to reduce her risk of refeeding syndrome during the first 4 to 5 days of administration using a solution of 20% lipid, 15% AA, and 25% dextrose. F. Calculate her final TPN goal using a solution of 20% lipid, 15% AA, and 25% dextrose. G. Based on final TPN goal, calculate her glucose infusion rate (GIR) (should be no greater than 5 mg/kg/min). (dextrose concentration (gm)/100) x rate of infusion (ml/hr) x 1000 mg/g Weight (kg) x (24 hours x 60 min)

Answer 1

A. BMI is body mass index

Weight of the patient is 226lbs = 226× 0.45 = 101.7 kg

Height of the patient is 5'6" = 1.67m

Her BMI = weight in kg / height in meters square

= 101.7/ 1.67 × 1.67

= 36.5

BMI Interpretation is obese

B. IBW = current weight + 2.3 kg for each inch over 5 feet

= 101.7 + 2.3× 6

= 115.5 kg

Given UBW = 270lbs = 270 × 0.45 = 121.5 kg

UBW % = current body weight / UBW × 100

= 101.7 / 121.5 × 100

= 83.7 %

#. % weight change = UBW - CURRENT WEIGHT / UBW × 100

= 270lbs - 226lbs / 270lbs × 100

= 16.2%

C. C. Mifflin-St Jeor Equation:

For women calorie estimate :

BMR = 10W + 6.25H - 5A -161

= 10× 101.7 + 6.25 × 1.67 - 5 × 38 - 161

= 1017+ 10.4 - 190 - 161

= 1027.4 - 190 - 161

= 837.4 - 161

= 676.4 calories

#. Protein need = 0.8gm /kg

= 0.8× 101.7

= 81.3gm

#. Fluid need = 1500ml + weight in kg × 20 ml/kg /day

= 1500ml + 101.7 × 20

= 1500+ 2034

= 3534ml