Question

Consider the following TPN medication order (Table 1) and the Stock Solutions (Table 2); then determine the exact volume of each component that should be used to compound the preparation. Round to the nearest whole mL. To receive all credit, show all work.

TABLE 1 Adult Total Parenteral Nutrition Central Line Total TPN Volume : _____________ (please supply) (1pt) Qs with H20:________________ (please supply) (1pt) To make 2400mL + 100mL overfill. Rate: _________________mL/hr (please supply rate for a 24 hour period) (2pts) Grams of Protein                      60 Grams of Lipid                          40 Grams of Dextrose                   300 Central Additives Calcium Gluconate                    5.6 mEq Magnesium Sulfate                   1 G Potassium Chloride                   40 mEq Sodium Chloride                         75 mEq Sodium Phosphate                   20 mM MVI                                              10 mL/day Vitamin K                                     1500 mcg/day Trace Elements -5                     4 mL/day

TABLE 2 Pharmacy, Stock Solutions Amino Acid 15 % Dextrose 70 % IV Fat Emulsion 20% Sodium Chloride 4mEq/mL Sodium Phosphate Na= 4mEq/mL PO4= 3mM/mL Potassium Chloride 2 mEq/mL Magnesium Sulfate 50% 4.06 mEq/mL, 10 mL Calcium Gluconate 10% 0.47 mEq/mL MTE-5 10 ml MVI 10 ml Phytonadione 2 mg/mL

Amino Acid=       ml	Magnesium Sulfate=      ml
Dextrose=      ml	Calcium Gluconate=      ml
IV Fat Emulsion 20 %=      ml	Sodium Phosphate=       ml
Sodium Chloride=      ml	Vitamin K (Phytonadione)=       ml
Potassium Chloride=      ml	Total mEq of sodium in TPN solution=       mEq

Answer 1

As per the table 1 and 2 calculation TPN for 2 patients /24 hours

1. Required protein is 60gm /day store available amino acid is 15% (60 gmX15% = 900ml)

2. Required Mgso4 is 1Gm and store available Inj Mgso4 is 50% and Mgso4 contains 1ml eual to 4.06 mEq (24.6 ml X 4.06 mEq = 1gm Mgso4

3. Required dextrose per day is 300 gm and store available dextrose is 70% ( 300X 1000ml /70% = 4285.7 ml/day

4. Required calcium gluconate is 5.6 mEq/day and store available 10 % of calcium gluconate contains 0.47 mEq/ml   (12 ml X 0.47 = 5.6 mEq/day)

      5. Required lipid is 40 Gm and store available fat is 20 % ( 40 gm X 20 = 800ml)

      6. Required sodium phosphate is 20 mM and store available is Na – 4 mEq/ml, P04- 3mEq/ml (2.86 ml X 7 mEq = 20 mM)

   7 Required sodium chloride dose is 75 mEq   and store available is 4mEq/ ml (18.75 X 4 = 75 mEq / day)

8 Required Inj Vit K 1500 mcg and available store is 2mg/ml ( 1500mcgX1ml / 2000 mcg = 075ml/per day)

9.Potassium chloride required dose 40mEq and store available is 2mEq/ml ( 40 mEq X 20ml = 40 MEq)

Amino Acid= 900 ml	Magnesium Sulfate= 24.6ml
Dextrose= 4285.7 ml	Calcium Gluconate= 12 ml
IV Fat Emulsion 20 %= 800 ml	Sodium Phosphate= 2.86 ml
Sodium Chloride= 18.75 ml	Vitamin K (Phytonadione)=       ml
Potassium Chloride= 20 ml	Total mEq of sodium in TPN solution= 86.44 mEq