A is ready to discharge with home TPN. Here is her discharge TPN recommendation: 17.5% dex, 2.5 g protein/kg/day, 1500 mL total fluid A is 8 yo.

A is ready to discharge with home TPN. Here is her discharge TPN recommendation: 17.5% dex, 2.5 g protein/kg/day, 1500 mL total fluid A is 8 yo. She weighs 28 kg with estimated needs 47-53 kcal/kg/d to meet her recommended daily allowance, plus catch up weight. TPN calorie needs are also estimated to be slightly lower than EN to correct for the thermic effect of food. Protein 1.5-2.5 g pro/kg/d based on critical illness Fluid 1650 mL per day fluid maintenances per Holliday Segar or per team Goal: GIR 5-10 mg/kg/min because adolescent but child-sized weight Follow the JH PN order form A. How many mL is the total PN recommendation providing? (0.25 pts) A. 1500mL 1. For a continuous infusion, what is the goal rate for the PN recommendation? (0.5 pts) 62.5mL/hr 2. How many total g of dex and kcal from dex is the PN recommendation providing? (1 pt) D17.5%= 17.5g dex 100g dex = 340kcal (100g dex/340 kcal) x (1/17.5) = 19.kcal/g 3. What is the GIR? Use https://www.pediatriconcall.com/calculators/glucose-infusion-rate-gir- calculator (0.25 pts) 6.5 mg/kg/min . How many total g of protein, kcal from protein, is the PN recommendation providing at 2.5 g protein/kg/day? (1 pt) 5. To protect the patient’s liver, the team would like to send her home on SMOF lipids. What lipids do SMOF provide? (0.5 pts) 6. What rate would the infusion be if SMOF were delivered in 18 hr three times per week to meet A’s goal of a fat infusion of 2 g/kg/d to meet essential fatty acid requirements? (1 pt) Conversation from g/kg/d to mL/hr = fat dose (mg/kg/d) * wt (kg) = g fat/day / (0.2 g/ml) = ml / hrs of infusion = mL/hr 7. How many kcals would the SMOF provide per week? (0.5 pts) 8. How many total kcals are delivered with PN infusion plus SMOF? Add the total kcals from carb and protein and weekly kcal from SMOF and divide by 7 for a daily average kcal intake. Then divide by the patient’s weight to check kcal/kg/d. Will her PN recommendation meet her energy needs? (1.5 pt)