[EricTAMUCC-BSN]

A patient asked me and I had no clue, how many calories are in a typical bag of TPN (approximatley 1500 to 2000ml)?

[jmgrn65]

Does it say it on the bag? I can't remember. Ask your nutrionist on the floor I bet they know.

[pricklypear]

I'm not sure, but I think it's based on the individual's caloric needs over a 24 hour period. Not a set amount, but unique to each patient.

[michelle126]

A few of us nurses on Weight watchers were taliking about IVF a while back, didn't look much for the TPN values, but here is what I found
http://allnurses.com/forums/showthre...light=calories

a dietician would know.

[hrtprncss]

I pretty much think depends on how much the concentration of the dextrose and how long the fat emulsion is ran wether it's 12h/day or continuous.

[suzanne4]

You have to caclulate it based on the amount of dextrose in it.
A 1000 ml bag of 5% Dextrose has 200 calories................

[EricTAMUCC-BSN]

The reason I ask is because I have a s/p rue en y gastric bypass patient who weighs over 400 lbs and we are trying to make sure we don't shoot ourself in the foot.

[EricTAMUCC-BSN]

maybe we should withhold the 250cc bag of lipids q24h?

[caroladybelle]

Originally Posted by EricTAMUCC-BSN

The reason I ask is because I have a s/p rue en y gastric bypass patient who weighs over 400 lbs and we are trying to make sure we don't shoot ourself in the foot.

The number of calories depends on the concentration of dextrose/additives/lipids. And these vary greatly from person to person and also varies day to day, as most TPN is tailored to the specific needs of the patient and generally based on the daily labs, I/O, weight and condition - in most facilities. The dietician, MD and PharmD all have input in what the best formulation is for the patient. Therefore, they should be the ones to make the decision on "withholding" lipids, etc.

As a matter of note, some MDs use lipids to help protect venous integrity, more so than for their calorie value. In addition, to just withhold lipids alters the balance of nutrients going into the bloodstream and could seriously destabilize the patient. All "withholding" of TPN/lipids should be decided by the MD/PharmD, with input from the dietician.

The TPN also frequently contains vital vitamins, electrolytes, and medications to maintain a certain balance in the patient.

While we generally want the gastric bypass patient to lose weight, it needs to be in a controlled manner, to prevent serious health consequences. Too rapid weight loss can cause serious health issues of itself. And while the patient may be worried about getting "sugar" water and "fats", adequate balanced nutrition is essential to proper recovery from surgery and good health.

[Tweety]

Carolina did an excellent job above and I don't have anything to add.

Post-op patients, even gastric bypass one's have high nutrition needs to help them heal and recover, so I wouldn't worry too much about the caloric content if I were you.

Over the years our MDs have allowed the "TPN team" which includes a dietician who calculates their nutrition needs based on condition, weight, (post op patients who weigh more have more caloric requirements), pre-albumin, etc. and a PharmD who writes the perscription based on the dietician's estimate of their needs, their other labs, etc. I can think of only one MD who writes his own script.