Fluids, Electrolytes & Nutrition: Nutritional Requirements

Estimated Energy Requirement (EER)

Basics

  • Estimated Energy Requirement (EER) Definition: Estimated Daily Calorie Requirement
  • *Indirect Calorimetry is Preferred Over EER if Available

Adult EER

  • Primary Requirements:
    • Healthy: 20-25 kcal/kg/d
    • Critically Ill (Trauma, Surgery or Sepsis): 25-30 kcal/kg/Day
  • Burn Patients:
    • Hypermetabolic State from Elevated Cortisol
    • Estimated EER = Normal EER + (30 x TBSA)
      • TBSA: Total Burn Surface Area
  • Morbidly Obese:
    • Decreased Daily Requirements
    • BMI 30-50: 11-14 kcal/kg/d for Actual Body Weight
    • BMI > 50: 22-25 kcal/kg/d for Ideal Body Weight

Pediatric EER

  • < 6 Months: 110-120 kcal/kg/Day
  • 6-12 Months: 95-100 kcal/kg/Day
  • 1-3 Years: 100 kcal/kg/Day
  • 4-6 Years: 90 kcal/kg/Day
  • 7-10 Years: 70 kcal/kg/Day
  • 11-14 Years: 47-55 kcal/kg/Day
  • 15-18 Years: 40-45 kcal/kg/Day

Macronutrient Requirements

Acceptable Macronutrient Distribution Ranges (AMDR)

  • Carbohydrates: 45-65% (3-8 g/kg/Day)
  • Fat: 20-35% (0.5-1.5 g/kg/Day)
  • Protein: 10-35% (0.8-1.0 g/kg/Day)

Calories Per Gram

  • Fat: 9 kcal/g
  • Protein: 4 kcal/g
  • Oral Carbohydrates: 4 kcal/g
  • Dextrose: 3.4 kcal/g

Ideal Body Weight (IBW)

  • Men = 106 lb + 6 lb For Each Inch > 5 ft
  • Women = 100 lb + 5 lb For Each Inch > 5 ft

Protein Requirements

  • 0.8-1.0 g/kg/Day: Well-Nourished
  • 1.0-1.5 g/kg/Day: Malnourished
  • 1.5-2.0 g/kg/Day: Postoperative Status, Sepsis or Trauma
  • 2.0-2.5 g/kg/Day: Large Burns or Obese
    • In Burns: Protein (g/Day) = Normal Requirement + (3 x TBSA)
      • TBSA: Total Burn Surface Area
  • *Decrease Rates in Patients with Renal Failure

Nitrogen Requirements

  • Give 1 G Nitrogen Per Every 150 kcal
  • There are Approximately 6.25 g Protein for Every 1 g of Nitrogen
    • Nitrogen Requirements (g/Day) = Protein Requirement / 6.25
    • Nitrogen Requirements (g/Day) = Weight (kg) x 1 (Protein g/kg/day) / 6.25(Nitrogen g/Protein g)