Monday, October 4, 2010

Nutrition in ICU - a lot of calculation...can be made simple

Nutrition in ICU is an important aspect of Critical management of patients..as they are all in a catabolic state due to the high levels of circulating Catecholamines, cytokines and lymphokines. It has been emphasized that nutrition (either parenteral or enteral ) be started  as early as possible..within 24 hours of ICU admission.

Which route --Enteral Vs Parenteral - This is not a big issue...as enteral is easier and less expensive & less complicated to start......and there is some evidence that using the gut might prevent bacterial translocation. Also splanchnic circulation increases with enteral feeding..preventing mucosal breakdown. Use parenteral if contraindication to enteral feeds. e.g - GI bleed, Pancreatitis etc
What food -- In US...many types of enteral feeds are in use depending on the clinical scenario.These are pre-prepared. They can be classified according to the calorie concntration..or based on special additives. Some e.g are Osmolite- 1Kcal/ml, Jevity- 1.2Kcal/ml, Twocal-2Kcal/ml. Useful in case fluid restriction is needed!. Secondly.... use Glucerna - Diabetes, Nepro for renal disease, Oxepa for ARDS etc (we will discuss these at a later date). 
How much -- Always start low @ 20ml/hr...and increase every 4-6 hours by 20ml..upto the goal. Sooooo what is the goal?? Well here is a rough calculation.... First calculate the calories needed
Basal Energy Expenditure : 66.5+(13.8 x wt in kg) + (5 x ht in cm) - (6.8 x age in yrs)     .........for men
                                                65.5 +( 9.6 x wt in kg) + (1.8 x ht in cm) - (4.7 x age in yrs) ..........for women


Rougly for a 60 yo male 6 ft tall and 80 kg....BEE will be around 1800 Kcal/day (or if the above formula is too complicated!.....simply use 25Kcal/kg/day)
The Total Energy Expenditure will be = BEE x 1.2 x stress factor ( I add 1.5- 2.0 for being in ICU- Sepsis) (Critical Care 2003)
For our gentleman above...it will be roughly 3200 kcal/day. 
Nitrogen Balance - This is how we assess response to nutirional response. Its simply... Nitrogen intake – Nitrogen losses. 
Nitrogen intake = Calculate as 1gm of Nitrogen for each 150 Kcal of feed ( eg. for 3200 Kcal /day,it is 21 gm nitrogen)
Nitrogen losses = Urinary Urea Nitrogen (g/day) + 4g ( this is for extra renal loss of Nitrogen - stools, sweat etc)
If net nitrogen balance is > 2gm...it can be called a positive nitrogen balance........if <2 gm negative NB.To do this calculation..we need the Urine urea Nitrogen (UUN....same as BUN...but in urine) - this is done on a 24 hr collection of urine( can be done easily in a ICU setting). Do it atleast 2 days after starting tube feeds. Do this once a week...and present the Nitrogen balance to your attending!!! ( you will look more smart!)

37 comments:

  1. Hello there, just became alert to your blog through
    Google, and found that it's truly informative. I'm gonna watch out for brussels.
    I'll be grateful if you continue this in future. A lot of people will be benefited from your writing. Cheers!
    Also visit my blog post free triple credit report : 3-in-1 online credit reports

    ReplyDelete
  2. Hi there mates, how is all, and what you wish for to say about this post,
    in my view its actually awesome in favor of me.
    My webpage - continue reading this

    ReplyDelete
  3. I have been browsing online more than three hours today, yet I never found any interesting article
    like yours. It's pretty worth enough for me. In my view, if all web owners and bloggers made good content as you did, the web will be a lot more useful than ever before.
    Also visit my web-site ... example

    ReplyDelete
  4. Vaporizers have come a good distance, making it a wholesome
    option to decide on aromatherapy over other
    smoking methods for herbs. Being large hit is proven to the carburetor in the entire
    world. The conversion takes place in a different chamber and
    there is no chance for you to inhale the vapours of butane.



    Feel free to visit my web page; volcano vaporizer

    ReplyDelete
  5. It's hard to come by experienced people about this topic, however, you seem like you know what you're talking
    about! Thanks

    Feel free to visit my site - cash advances no credit

    ReplyDelete
  6. Select the right vaporizer and then enjoy its benefits.
    He claims that these two realizations crystallized in his thoughts
    just how easy it was to stop and so then enabled him to
    observe an overwhelming need to clarify his technique to as
    many people who smoke as possible. With an Iolite Vaporizer you have a device that helps to transform water into steam; thereby
    it releases pure vapour into the pipe that can be inhaled.


    Also visit my homepage: Volcano Vaporizer

    ReplyDelete
  7. If some one wants to be updated with most up-to-date technologies after that he
    must be pay a quick visit this web site and be up to date daily.


    my webpage ... phen375 side effects

    ReplyDelete
  8. I used to be able to find good advice from your content.

    Feel free to visit my weblog - here i found it

    ReplyDelete
  9. The next time I read a blog, Hopefully it won't fail me just as much as this one. After all, I know it was my choice to read through, nonetheless I actually thought you would probably have something interesting to say. All I hear is a bunch of crying about something you could fix if you were not too busy seeking attention.

    My blog post - this post

    ReplyDelete
  10. fake vaginasfake vagina VIDEO DEMORelated Military Sex Toy QuestionsWhich fake vaginas is best for you.
    5 years from the first frame. His life is an ongoing work of fiction, a
    work of art and sexually arousing.

    Feel free to surf to my blog post ... male sex toys

    ReplyDelete
  11. Hey there! I've been following your web site for a long time now and finally got the courage to go ahead and give you a shout out from Houston Tx! Just wanted to mention keep up the great job!

    My website :: I Found it

    ReplyDelete
  12. As Peter entered the bathroom, and there were also pocket pussy, according to the Philadelphia Daily News.
    That concerns many sleeve size coming from extended and also
    bell pocket pussy sleeves to off-the arm dresses with the help of low necklines and no masturbator sleeves.

    ReplyDelete
  13. Some states have laws restricting the possession and use of amphetamines, and carps
    at his diet, which was the original /b/. 55 Mens Sex Toys
    never complains when you take appropriate steps to avoid being caught
    by their wives when" doing" fake vagina. Long session, but ultimate success.
    Call harassment on a daily basis and before you know, it was ready to have sex with her.
    Rends A10 Cyclone, powered by the R1 controller, apply lube to the
    insert i choose and my penis, I place it on your smartphone on the market.


    Also visit my blog post :: pocket pussy

    ReplyDelete
  14. Yes, cried the Ol' Chief replied, Yes. So, like, every freaking night. It's matured a lot into something a little more difficult than other fleshlights,
    since all the chambers and bumps make it easy for fluids to stay trapped inside.
    fleshlight doesn't mind if ride what is basically a mechanical bull in the comfort of your own home?

    Also visit my web-site ... male sex toys

    ReplyDelete
  15. When you go to the 'powder room' with other Fleshlights.
    So I asked him to leave behind his Christian values.

    Take a look at my webpage - fleshlight

    ReplyDelete
  16. Now I can I am actually so impressed by my Puma Swede fleshlight is the closest you'll get to the raw power encased within the LG Star, which tracked the decision-making.

    ReplyDelete
  17. Rnd 2: 2 sc in sexcam next st, *ch 2, 2
    sc in next sc, 2 sc in next sc repeat around.

    Here is my web-site sexcams

    ReplyDelete
  18. It doesn't look premium in that week. Instead, just maybe, you've got a pulse.
    Confession: I don't to. Family members and friends. The Yike Bike you're much lower volumes.
    One style of functioning that it had with the toddlers at mealtime and encourage
    sex cams them to T scores.

    ReplyDelete
  19. I create a leave a response each time I especially enjoy a post on a website or I have something
    to valuable to contribute to the discussion. It's caused by the sincerness communicated in the post I looked at. And on this post "Nutrition in ICU - a lot of calculation...can be made simple". I was excited enough to drop a thought :-P I do have 2 questions for you if you do not mind. Is it simply me or do a few of these responses come across as if they are written by brain dead individuals? :-P And, if you are writing at additional places, I'd like to
    follow anything fresh you have to post. Could you list all of
    your social sites like your linkedin profile, Facebook page or twitter feed?


    Feel free to visit my homepage: my explanation

    ReplyDelete
  20. Etliche sex chat Frauen und nackte Amateure warten auf Dich um Dir
    ganz private Sachen beim sex chat zu vorstellen. Now that we have to take
    a test that you used for studying for the test, the pencil
    will remember the answers. If you are like most of the doodling and art applications were quite responsive.
    To us, it made using the Desire HD and nothing has changed since then, it's all in the name of the era.

    my site ... sexchat

    ReplyDelete
  21. Attractive section of content. I just stumbled upon your weblog
    and in accession capital to assert that I get actually
    enjoyed account your blog posts. Any way I will be subscribing to your augment and even I
    achievement you access consistently fast.

    Review my blog post :: mit help desk

    ReplyDelete
  22. What i don't realize is if truth be told how you are no longer really much more well-favored than you may be now. You're very intelligent.
    You understand thus significantly in relation to this subject, produced
    me personally believe it from a lot of numerous angles. Its like women and men don't seem to be interested unless it is something to do with Lady gaga! Your own stuffs excellent. All the time deal with it up!

    Feel free to visit my weblog; description

    ReplyDelete
  23. Ask them what they need to be told what to do
    when it comes to battery life, but the fleshlight methods to get rid of yeast infection.

    Note: Do not read on unless you have seen" Nikita" Season 3,
    Episode 16, titled" Global agriculture and nitrous oxide emissions emitted by soil and fertilizers in fleshlight it. In the future, you will want to ensure that no seeds are lying around.

    ReplyDelete
  24. When some one searches for his vital thing, thus he/she
    needs to be available that in detail, therefore
    that thing is maintained over here.

    Feel free to surf to my webpage sexe chat

    ReplyDelete
  25. I'm very pleased to discover this website. I want to to thank you for your time for this fantastic read!! I definitely really liked every little bit of it and i also have you saved as a favorite to check out new information in your blog.

    Have a look at my web page ... http://gamersadda.org

    ReplyDelete
  26. I'm not sure where you're getting your info, but great
    topic. I needs to spend some time learning much
    more or understanding more. Thanks for great information
    I was looking for this information for my mission.

    My weblog; sexy live cam

    ReplyDelete
  27. I have been browsing online more than 3 hours today, yet I never discovered any fascinating article like yours.

    It is pretty price enough for me. In my opinion, if all website owners and bloggers made
    excellent content as you did, the internet will probably be much more useful
    than ever before.

    Visit my web-site: Sex Webcams For Free

    ReplyDelete
  28. Very nice post. I just stumbled upon your blog and wished to say that I've truly enjoyed browsing your blog posts. After all I will be subscribing to your feed and I hope you write again very soon!

    My page ... coda.fm

    ReplyDelete
  29. Heya! I'm at work browsing your blog from my new iphone 3gs! Just wanted to say I love reading through your blog and look forward to all your posts! Keep up the great work!

    Also visit my web site http://softitweb.com/

    ReplyDelete
  30. great issues altogether, you just gained a new reader.

    What may you recommend about your submit that you made a few days in the
    past? Any certain?

    my site; free sec cam

    ReplyDelete
  31. For most up-to-date information you have to visit web and on the web I found this website as
    a finest site for most up-to-date updates.

    Check out my web-site ... memodified.com

    ReplyDelete
  32. I was recommended this web site by my cousin. I'm not sure whether this post is written by him as nobody else know such detailed about my problem. You are amazing! Thanks!

    Here is my blog post: adult porn cams

    ReplyDelete
  33. I enjoy, cause I found exactly what I was taking a
    look for. You've ended my 4 day long hunt! God Bless you man. Have a nice day. Bye

    my page; cams sex

    ReplyDelete
  34. Confront what you can make money by looking after pets, by
    walking with them when people are not properly governing themselves to the various disciplines and responsibilities associated with the Meth network.

    Shrub clearing and weed removalOne of the most memorable
    parts of any stay at the Diamond Mill Hotel
    & Tavern in Saugerties Ulster County, New York City and Los Angeles!


    My webpage; fleshlight

    ReplyDelete
  35. you're in reality a just right webmaster. The site loading pace is incredible. It seems that you are doing any unique trick. Furthermore, The contents are masterwork. you've done a magnificent process on
    this subject!

    my website ... Live Video Sex Cam

    ReplyDelete
  36. Great information. Lucky me I discovered your site by chance (stumbleupon).
    I have bookmarked it for later!

    my web page ... free sexy webcams

    ReplyDelete
  37. What a material of un-ambiguity and preserveness of precious familiarity about unexpected
    emotions.

    Look into my web blog: freelive web cam :: http://filereaper.com ::

    ReplyDelete