Initiation of Intralipid should begin slowly in infants with 1 g/kg/day for
those less than 2 kg or 2 g/kg/day for patients who are over 2 kg. Advancement
in lipids should be 0.5 to 1 g/kg/day while simultaneously monitoring serum
triglyceride levels to keep levels below the 150 to 200 mg/dL range. The
maximum dose in infants and children is 4 grams/kg/day and 2 grams/kg/day in
adults. Higher doses may have deleterious effects on reticuloendothelial and
pulmonary function. Lipids may provide up to 50% of total calories. Lipid
administration can be given in peripheral veins. Intolerance to lipid may occur
with overly rapid administration or in patients who are septic. Serum triglyceride
levels should be obtained following any increase of parenteral lipid and at regular
intervals during maintenance phase.
Protein should be started at 2.5 g/kg/day and advanced by 1 g/kg/day to a
maximum of 4 g/kg/day for preterm infants, 3 g/kg/day for term infants and 1-2.5
g/kg/day for children and adults.
C. Guide to Daily Preparation of Parenteral Nutrition
- Calculate maintenance fluid requirements using ideal body weight:
4ml/kg for the 1st 10 kg, 3ml/kg for 2nd 10 kg, then 1ml/kg for >20 kg - Calculate daily caloric needs: 100 kcal/kg for the first 10 kg, 50 kcal/kg
for the 2nd 10 kg, and 20 kcal/kg for each kg>20 kg - Caloric distribution: 30-40% from fat, 50-60% from carbohydrates and
8 - 12% from protein.