Manual of Clinical Nutrition

Calculating Total Parenteral Nutrition

Manual of Clinical Nutrition Management III- 102 Copyright © 2013 Compass Group, Inc.

3. Determine volume of 10% AA solution.
   gm protein ÷ gm/100 mL stock solution = volume of stock solution
   70 gm ÷ 10 gm/100 mL = 700 mL 10% AA solution.


4. Determine volume of 20% lipid.
   250 mL (see III.B.2.)
   In a 2-in-1 solution, this is separate from the TPN solution. This will leave 1,000 mL
   for AA and dextrose.


5. Determine volume of sterile water and additives.
   Desired volume TPN solution – (volume of dextrose + volume AA) = volume for water
   and additives.
   1,000 mL – (383 mL + 700 mL) = 83 mL
   These volumes of stock solution do not fit into the desired TPN volume.


6. Adjust solution.
   a. Determine the volume available for dextrose.
   Desired volume – (volume of AA solution + volume for additives) = volume
   available for dextrose.
   1,000 mL – (700 mL + 50 mL) = 250 mL
   Usually, 50-100 mL is needed for additives.
   b. Determine new grams of dextrose.
   Volume of dextrose x solution concentration = gm dextrose stock solution
   250 mL x 70 gm/100mL = 175 gm dextrose
   c. Determine dextrose concentration.
   gm dextrose x 100 = % dextrose
   TPN volume
   175 gm x 100 = 17.5% dextrose
   1,000 mL
   B. 3 - in-1 solution with fluid restriction of 1,250 mL.


7. Determine TPN volume and grams of carbohydrate, protein and fat (see III.D.).
   1,250 mL
   268 gm carbohydrate
   70 gm protein
   56 gm fat


8. Determine volume of 70% dextrose solution.
   gm dextrose ÷ gm/100 mL stock solution = volume of stock solution
   268 gm ÷ 70 gm/100 mL = 3 83 mL 70% dextrose solution


9. Determine volume of 10% AA solution.
   gm protein ÷ gm/100 mL stock solution = volume of stock solution
   70 gm ÷ 10 gm/100 mL = 700 mL 10% AA solution


10. Determine volume of 20% lipid.
    gm fat ÷ gm/100 mL stock solution = volume of stock solution
    56 ÷ 20 gm/100 mL = 280 mL 20% lipid


11. Determine volume of sterile water and additives.
    Desired TPN volume – (volume dextrose solution + volume AA solution + volume
    lipids = volume of water and additives
    1,250 mL – (383 mL + 700 mL + 280 mL) = -113 mL
    This solution will not compound.


12. Adjust solution.
    a. Determine the volume available for dextrose.
    Desired volume – (volume of AA solution + volume lipid + volume additives) =
    volume available for dextrose
    1,250 mL – (700 + 280 + 50) = 220 mL
    b. Determine new grams of dextrose.
    Volume of dextrose x solution concentration = gm dextrose stock solution
    220 mL x 70 gm/100 mL = 154 gm dextrose
    c. Determine new dextrose concentration.
    gm dextrose x 100 = % dextrose
    TPN solution
    154 gm x 100 = 12.3% dextrose
    1,250 mL
    Reprinted by permission: from Fish J. Worksheet for calculating total parenteral nutrition. Support Line. 1995: 17(6): 10-13.