Nutrition equations

Ideal body weight:

Females: 100 lb (45 kg) for first 5 ft (152 cm) plus 5 lb (2.3 kg) for each additional inch (2.54 cm) Males: 106 lbs (48 kg) for first 5 ft (152 cm) plus 6 lbs (2.7 kg) for each additional inch

Caloric requirements:
Harris - Benedict equations: Males: REE = 66.47 + 13.75(IBW) + 5.0H - 6.76A Females: REE = 655.1 + 9.5(IBW) + 1.85H - 4.68A EE = 606S + 9W -12A +400V +1,444 EE = 1925 - 10A + 5W + 281 S + 292T + 851B

Ireton-Jones equation for obese patients: Ireton-Jones equation for ventilator patients:

REE -- resting energy expenditure in kcal/day; needs to be corrected for stress. EE -- energy expenditure in kcal/day (no stress correction required). IBW -- ideal body weight (kg); H -- height in cm, A -- age in years, S -- sex (1=male, 0=female), T -- trauma (0=absent, 1 = present), B -- burn (0 = absent, 1 = present)

Weight based calculations:

Disease state Usual maintenance diet Obesity (weight loss desired) Mild to moderate illness Renal disease Estimate of caloric requirements 20-25 kcal/kg/day 15-20 kcal/kg/day 25-35 kcal/kg/day maintenance: 35 kcal/kg/day weight gain: 40-50 kcal/kg/day weight loss: 25-30 kcal/kg/day 30-35 kcal/kg/day 35-45 kcal/kg/day 45-50 kcal/kg/day

Sepsis, multiorgan system failure, trauma Chylothorax, head trauma Pancreatitis, inflammatory bowel disease

Methods of indirect calorimetry:

Weir equation for indirect calorimetry Sherman equation using mixed expired CO2 Ligget - St. John - LeFrak equation using thermodilution cardiac output MEE = 1.44 (3.9 VO2 + 1.1 VCO2) MEE = 9.27 (PECO2)(VE) MEE = 95.18 (CO) (Hb) (SaO2-SvO2)

MEE = measured energy expenditure in kcal/day. VO2 oxygen consumption in ml/min, VCO2 -- carbon dioxide production in ml/min. PECO2 partial pressure of expired carbon dioxide (collect several liters of expired gas in nonpermeable bag, mix, withdraw 10 cc and analyze with blood gas machine); VE -- minute ventilation in liters/min. CO cardiac output (l/m), Hb hemoglobin; SaO2 and SvO2 are arterial and mixed venous saturations respectively.

Estimated Protein Requirements:

Minimal intake Recommended (RDA) intake Catabolic States Multiorgan system failure 0.54 g/kg/day 0.80 g/kg/day 1.2 - 1.6 g/kg/day Stable: 1.2 - 1.5 g/kg/day Stressed: 2.0 g/kg/day Cancer COPD with malnutrition HIV infection Renal disease 1.5 g/kg/day 1.5 - 2.0 g/kg/day 1 - 1.2 g/kg/day No dialysis: 0.6 g/kg/day Hemodialysis: increase to1.2 g/kg/d Peritoneal dialysis: 1.2-1.5 CAVHD: 1.5-1.8 1.5 - 2.0 g/kg/day 1.3 - 2.0 g/kg/day

Trauma Hepatic cirrhosis

1.5 - 2.0 g/kg/day Chylothorax 1.5 g/kg/day dry weight Pancreatitis/inflammatory If encephalopathic: 0.5 bowel disease 0.7 g/kg/d dry weight Adjust above to aim for Nitrogen Balance of +2-4 g/day: Nitrogen balance = 0.16 (g protein intake/day) - (UUN + 4) UUN -- 24 hour urine urea nitrogen.

Fluid Requirements:
1. 35 ml/kg body weight OR 2. 1500 ml/m2 body surface area 3. Add 150 ml/day for every degree over 37C Aspen Board of Directors. Guideline for the use of parenteral nutrition in adult and pediatric patients. JPEN 17(4S):7-26SA, 1993 Gottschilich MM, Matarese LE, Shronts EP. Nutrition Support Core Curriculum, Aspen Publications, 1993 Schlitig et al., Nutritional Support of the critically ill. Yearbook Medical Publishers, Chicago, 1988