SDMC TPN
Date of Order:
Patient Name:
Patient Weight (grams):
Calories (Kcal/kg):
Type of Line:
Peripheral
Central
Osmolarity (Osm/L):
TPN Fluid Rate (ml/kg/day):
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
Fluid Rate (ml/hr):
Dextrose (%):
5%
7.5%
10%
12.5%
15%
18%
20%
25%
GIR (Glucose Infusion Rate):
ⓘ
Protein (gm/kg/day):
1
2
3
3.5
4
Lipid Type:
None
SMOF
Intralipids
Omegavan
Lipid Rate (gm/kg/day):
Lipid Rate (ml/hr):
NaCl (mEq/kg/day):
1
2
3
4
5
7
8
10
Na Acetate (mEq/kg/day):
1
2
3
4
5
Na Phosphate (mmol/kg/day):
1
1.2
1.5
1.7
2
KCl (mEq/kg/day):
1
2
3
4
5
K Acetate (mEq/kg/day):
1
2
3
4
5
K Phosphate (mmol/kg/day):
1
1.2
1.5
1.7
2
Ca Gluconate (mg/kg/day):
400
500
600
800
1000
1200
Magnesium Sulfate (mEq/kg/day):
0.5
Heparin Preservative Free (units/ml):
0
0.5
MVI ped inj (ml):
0
2.5
5
Trace Elements (mcg/kg):
None
Zinc 250, Copper 20, Selenium 3
Zinc 400, Copper 20, Selenium 5
ⓘ
Carnitine (mg/kg/day):
10
ⓘ
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