Site hosted by Angelfire.com: Build your free website today!

Clinical Notebook & Related Formulas

Energy Needs

Males: 106 lbs + 6 lbs per inch over five feet
BEE Males: 66 + (13.7 x W) + (5 x H) - (6.8 x A)
Females: 100 lbs + 5 lbs per inch over five feet
BEE Females: 655 + (9.6 x W) + (1.8 x H) - (4.7 x A)

W = weight in kg; H = height in cm; A = age in years

Frame Adjustments
  • Small Frame: Subtract 10%
  • Large Frame: Add 10%
Obesity Adjustment (> 125% IBW) (Actual BW - IBW) x .25 + IBW

Activity and Injury Factors

Activity Factors
  • Ambulatory: 1.3 X BEE
  • In bed (hospital): 1.2 x BEE
Injury Factors (Very General)
  • Surgery: 1.1 - 1.2
  • Trauma: 1.1-1.4 (maybe BEE x 2.0)
  • Infection: 1.1 - 1.5

Protein Requirements

Method #1: g pro/kg body weight
  • healthy, non-stressed individual: 0.8 g/kg
  • non-stressed hospital patient: 1.0 g/kg
  • malnourished hospital patient: 1.2 g/kg
  • trauma, burns: 1.5-2.0 g/kg
  • head injury: 1.5-2.0 g/kg

Method #2: Kcal:N Ratio

  • healthy, non-stressed individual: 300:1
  • non-stressed hospital patient: 200:1
  • malnourished hospital patient: 150:1
  • trauma, burns: 80-100:1

Fluid Requirements

  • Children over 20 kg: 1500cc + 30cc/kg above 20 kg
  • Young adults with large muscle mass: 40cc/kg/day
  • Adults (Age 18-55): 35 cc/kg
  • Older adults: 30cc/kg

Normal Lab Values

Leukocytes: 5-10 K/cubic millimeter
Lymphocytes: 1.5-3 K/cubic millimeter
MCH: 27-31 pg
MCV: 80-105/cubic micron
MCHC: 32-36%
Hct:
  • Males: 40-54 ml/dl
  • Females: 37-47 ml/dl
Hgb:
  • Males: 14-18 g/dl
  • Females: 12-16 g/dl
Bilirubin:
  • Direct: 0.1-0.4 mg/dl
  • Indirect: 0.2-0.7 mg/dl
  • Total: 0.3-1.1 mg/dl
Serum Osmolality:
  • 280-305 mOsm
  • To Calculate: [(2Na+K) + BUN/2.8 + Glucose/18]
Calcium:
  • 4.5-5.5 mEq/L
  • To Calculate Adjusted Calcium: (4.0 - Alb) x 0.8 + Ca
CO2: 24-40 mEq
pCO2: 35-45 mmHg
Creatinine: 0.7-1.5 mg/dl
Glucose: 70-115 mg/dl
TIBC: 250-410 ug/dl
Magnesium: 1.5-2.5 mEq/L
Phosphate: 3.0-4.5 mg/dl
Potassium: 3.5-5.0 mEq/L
Albumin
  • Normal: 3.5-5.5 mg/dl
  • Mild Depletion: 2.9-3.4 mg/dl
  • Moderate Depletion: 2.2-2.8 mg/dl
  • Severe Depletion: Less than 2.2 mg/dl
Sodium: 136-145 mEq/L
Triglycerides: 0-150 mg/dl
Urea: 24-49 mg/dl
BUN: 10-20 mg/dl
Transferrin: >200 mg/dl
Total Cholesterol: <200 mg/dl
HDL Cholesterol: >35 mg/dl

Nutritional Anemias

Iron Deficiency
  • Low Hgb, Hct, MCV, and Serum Iron
  • Elevated TIBC
  • RBC usually near normal
B12/Folate
  • Low Hgb, Hct, and TIBC
  • Elevated MCV and Serum Iron
Vitamin E (Hemolytic anemia)
  • Usually seen in infants

Other Calculations

TPN calculations
  • D50: 1.7 kcal/cc
  • 10% Lipids: 1.1 kcal/cc
  • 20% Lipids: 2.0 kcal/cc
  • Crystalline Amino Acids: 4.3 kcal/cc
  • Generic Carbohydrate: 3.4 kcal/cc
  • 8.5% Amino Acids: 0.085 grams Protein/cc
  • 10% Amino Acids: 0.100 grams Protein/cc
Est. blood glucose from HgbA1c:
  • HgbA1c x 17 = usual blood glucose
  • Do NOT use MCT oil in diabetics as it may increase blood glucose
Burn mortality rate:
  • Age x % 3rd degree burns x (0.5) 2nd degree burns
  • Do NOT use MCT oil in COPD as it increases the ventilatory drive (increase CO2 production)
Maximum Lipids given to prevent Fatty Liver is 60% of total kcal or 3g/kg Maximum glucose that is tolerated is 5 mg/kg/minute Factors that may increase blood glucose
  • Stress
  • Medications
  • TPN/PPN
  • Infection

SOAP Note Information

Case Study Index

Comments & Suggestions

Contents of this publication are subject to change without notice. The provisions of this publication do not constitute a contract, expressed or implied between any applicant, student, or faculty member of the College of Allied Health. The University of Oklahoma is an Equal Opportunity Institution.

This page was last updated on
Monday, June 15, 1998 03:55 PM
Page maintained by
Marinell Guild, M.S., RD/LD, FADA
marinell-guild@ouhsc.edu