Page 629 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

616 SPECIAL THERAPY

BOX 25-4 Worksheet for Calculating a Total Parenteral Nutrition
Formulation
1. Resting energy requirement (RER)
70 (current body weight in kilograms) 0.75 ¼ kcal/day or for animals 3-25 kg, can also use:
30 (current body weight in kilograms) þ 70 ¼ kcal/day
RER ¼ ____kcal/day

2. Protein requirements Canine Feline
*Standard 4-5 g/100 kcal 6 g/100 kcal
*Decreased requirements (hepatic/renal failure) 2-3 g/100 kcal 4-5 g/100 kcal
*Increased requirements (protein-losing conditions) 5-6 g/100 kcal 6-8 g/100 kcal
(RER 100) ____g/100 kcal ¼ ____g protein required/day (protein required)
3. Volumes of nutrient solutions required each day
a. 8.5% amino acid solution ¼ 0.085 g protein/mL
____g protein required/day 0.085 g/mL ¼ ____mL of amino acids/day
b. Nonprotein calories:
The calories supplied by protein (4 kcal/g) are subtracted from the RER to get total nonprotein calories needed:
____g protein required/day 4 kcal/g ¼ ____kcal provided by protein
RER kcal provided by protein ¼ ____nonprotein kcal needed/day
c. Nonprotein calories are usually provided as a 50:50 mixture of lipid and dextrose. However, if the patient has a preexisting
condition (e.g., diabetes, hypertriglyceridemia), this ratio may need to be adjusted:
*20% lipid solution ¼ 2 kcal/mL
To supply 50% of nonprotein kcal:
____lipid kcal required 2 kcal/mL ¼ ____mL of lipid
*50% dextrose solution ¼ 1.7 kcal/mL
To supply 50% of nonprotein kcal:
____dextrose kcal required 1.7 kcal/mL ¼ ____mL dextrose
4. Total daily requirements
____mL 8.5% amino acid solution
____mL 20% lipid solution
____mL 50% dextrose solution
____mL total volume of TPN solution
5. Administration rate
Day 1: ____mL/hr
Day 2: ____mL/hr
Day 3: ____mL/hr
*Be sure to adjust the patient’s other fluids accordingly.
*Note: Fluids can be added directly to TPN if desired (at the time of compounding only).
*The monitoring required will depend on the individual patient. However, at least the following should be measured daily:
*Heart/respiratory rate
*Catheter site
*Attitude
*Body weight
*Temperature
*Glucose, total solids (check hematocrit tubes for lipemia)
*Electrolytes (especially potassium) should be monitored at least every other day

ADMINISTRATION the risk of thrombophlebitis. Short catheters and
Catheters catheters composed of polyvinyl chloride or polyethylene
should be avoided. The catheter should be “dedicated”
Administration of parenteral nutrition requires a catheter (i.e., it should not be used for any other purpose [e.g.,
that is placed using aseptic technique (Figure 25-6). administering medications, collecting blood samples,
Adherence to aseptic technique is crucial because the skin measuring central venous pressure] than administration
has been identified as the most common source of cathe- of parenteral nutrition). If a multilumen catheter is used,
ter-related infections. 2,7,50,56 Long catheters composed
a single port should be dedicated to parenteral nutri-
of silicone, polyurethane, or tetrafluoroethylene are 56
tion. Multilumen catheters are very useful for patients
recommended for use with parenteral nutrition to reduce
receiving parenteral nutrition because they can remain