PERHITUNGAN

TPN SET (3)

http://www.free-powerpoint-templates-design.com
 KELOMPOK 2
01 Novian Malik Prabowo
1808062126

02 Lucy Meyrintan
1808062127

03 Windy Risky Lestari

1808062128

04 Sunengsih
1808062129

05 Anisma Azwati
1808062130
A 80 yo, 86 lb, 5’ 0” female with pneumonia and
dementia is refusing to eat. She is to be placed
on TPN while her infection resolves, in the hope
that she will begin eating again. Labs are :

Calculate her nutritional needs using both the pre-set volume and
the pump methods.
 Zat Nilai pada kasus Nilai Normal

Sodium 135 mEq/L 135 – 150 mEq/L

Potassium 4.4 mEq/L 3.5 – 5.0 mEq/L
Chloride 104 mEq/L 100 – 106 mEq/L
Bicarbonate 26 mEq/L 24 – 30 mEq/L
BUN 26 mg/Dl 8 – 20 mg/dL
Creatinine 0.6 mg/dL 0.6 – 1.2 mg/dL
glucose (fasting) 123 mg/dL 70 – 110 mg/dL
Calcium 8.5 mEq/L 8.5 – 10 mEq/L
Phosphate 3.7 mg/dL 2.6 – 4.5 mg/dL
Magnesium 2.1 mEq/L 1.8 – 2.5 mEq/L
3.5 – 5 g/dL (long-term
Albumin 2.0 g/dL
nutritional status)
Data
Jenis kelamin = Perempuan IBW = 45,5 + 2,3 (H-60)
Pasien Umur = 86 tahun
Tinggi Badan = lb 5 kaki 0 inci
= 45,5 + 2,3 x
(60 inci - 60 inci)
= 45,5 + 0
= 1 kaki = 12 inci
= 45,5 kg
= 1 inci = 2,54 cm
= 5 x 12 inci = 60 inch Feed Weight = (ABW + IBW)/2
= 60 inci + 0 inci = (39 kg + 45,5 kg)/2
= 60 inci x 2,54 cm = 42,25 kg
= 152, 4 cm ≈ 153 cm
ABW = 86 lb (pound)
= 1 pound (0,453 kg)
= 86 x 0,453
= 38,958 ≈ 39 kg
Pre-set Volume and
Pump Methods
 Kebutuhan cairan perhari

01

Kebutuhan cairan = 1500 + 20 ml (39-20)

= 1880 ml/hari
02 Atau 30-35 ml/kg/hari
= 30x39 = 1170 ml/hari
= 35x39 = 1365 ml/hari
Rata-rata = (1170 + 1365) : 2 = 1267~ 1270
ml/hari
Range : 1270 – 1880 ml/hari
Pasien menderita hiperglikemia maka
untuk BB < 60 kg perlu penambahan 1000
03 mL/hari. Maka, jumlah kebutuhan cairan
pasien diatas adalah 2270 mL/ hari
Kebutuhan
Protein
• Hospitalized patient = 1-1,2 g/kg/hari
• Untuk pasien 39 kg
1 g/kg/hari x 39 kg = 39 g/hari
1,2 g/kg/hari x 39 kg = 46,8 g/hari +
85,8 g/hari
• Kebutuhan Protein rata-rata
= (85,8 : 2) g/hari
= 42,9 g/hari ~ 43 g/hari
Non-protein
calories
BEE woman = 665,1 + 9,56(W)+1,86(H)-4,68(A=Umur)
= 665,1 + 9,56(39)+1,86(153)-4,68(80)
= 665,1 + 372,84 + 284,58 - 374,4
= 948,12 ~ 948 kkal
Activity factor (di tempat tidur) = 1,2
Stress factor  infection = 1,4
TDE = (BEE) x (activity factor) x (stress factor)
= 948 x 1,2 x 1,4
= 1592,64 ~ 1593 kkal/hari
Jumlah Total
TPN Volume
Total TPN volume 2270 ml/hari

Digunakan sediaan yang

kemasannya 1000 ml/bag

Volume untuk masing-masing:

TPN 1135 ml/bag
jadi dibutuhkan 2 bag/hari.
Volume
Protein
Kebutuhan protein metode pump = 43 g/hari
Kebutuhan protein metode pre-set = 43/2 bag
= 21,5g/bag.

Volume Protein = 10% AA = 50g dalam 500 ml

Untuk 21,5 g = 21,5 g x 500 ml = 215 mL/bag
50 g
Kebutuhan
Dextrosa
3.5 mg/kgBB/min
Untuk W 39 kg = 3,5 mg/kgBB/min x 39 kg x (24jam x 60 min)
= 196.560 mg/hari ~ 196,56 g/hari ~ 197 g/hari
(Metode Pump)
Untuk 1 bag = 197 g/hari : (2)
= 98,5 g/bag (Metode Preset)

Volume dextrose tiap bag

98,5 g/250 g x 500 ml = 197 ml

Kebutuhan kalori dextrose = 3,4 kcal/g x 197 g/hari

= 669,8 kcal/hari ≈ 670 kcal/hari .
Volume
Lemak
Jumlah kalori fat (metode pump) = non protein
kalori-dextrose
= 1593 kkal/hari – 446 kkal/hari
= 1147 kkal/hari

Jumlah kalori fat per-bag (metode pre-set)

= 1147 : 2 = 573,5 kkal/bag
Gunakan 900 kkal / 500 ml lipid of 20 %
volume lemak = 573,5 kkal/hari x 500 ml
900 kkal/hari
= 318,6 ml/bag
Volume water
Jumlah volume Total = 1200 mL/ bag
steril
• Volume protein = 143 mL
• Volume dextrose = 131 mL
• Volume Fat = 212 ml

Vol sisa = 1200 mL - 143 mL - 131 mL - 212 mL

= 714 ml  perhitungan elektrolite

Infusion Rate = 2400 ml/hari

= 100 ml/jam
= 1,6 ml/menit
 Kebutuhan
Amt/1000 (amt)(daily

Elektrolit Electolyte
cals cals)/1000
Range Rata-rata Amount/bag

(40-50) x
Kebutuhan kalori lemak + dekstrosa Sodium 40-50 mEq 64-80 72 mEq 36 mEq
1593 /1000
= 1147 + 446
= 1593 kkal / hari 40 x 1593 /
Potassium 40 mEq 64 64 mEq 32 mEq
1000

(8-12) x
Magnesium 8-12 mEq 13-19 16 mEq 8 mEq
1593 / 1000

(2-5) x 1593
Calcium 2-5 mEq 3-8 5,5 mEq 2,25 mEq
/ 1000

(15-25) x
Phosphate 15-25 mMol 24-40 32 mMol 16 mMol
1593 / 1000
 Jumlah Elektrolit
yang ditambahkan metode pre-set
Volume to
elektrolit Perhitungan
add (ml)
Sodium chloride 23,4% (4 mEq/ml) 24 mEq : 4 mEq/ml 6

Sodium acetate 16,4 % (2 mEq/ml) - -

Potassium phosphate ; 3 mMol 10,6 mMol : 3 mMol/ml
3,5
phosphate/ml, 4.4 mEq potassium/ml
4,4 mEq/ml potassim x 3,5 ml = 15,54
mEq
Potassium chloride 2mEq/ml 2,88
21,3 mEq – 15,54 mEq = 5,76 mEq
5,76 mEq : 2 mEq/ml = 2,88 ml
Magnesium sulfate 4 mEq/ml 5,4 mEq : 4 mEq/ml 1,35

Calcium gluconate 10 % (0,465 mEq/ml) 1,8 mEq : 0,465 3,87

Total 18 ml
 Jumlah Elektrolit
yang ditambahkan metode pump
Volume to
elektrolit Perhitungan
add (ml)
Sodium chloride 23,4% (4 mEq/ml) 72 mEq : 4 mEq/ml 18

Sodium acetate 16,4 % (2 mEq/ml) - -

Potassium phosphate ; 3 mMol 32 mMol : 3 mMol/ml
10,7
phosphate/ml, 4.4 mEq potassium/ml
4,4 mEq/ml potassim x 10,7 ml = 46,93
mEq
Potassium chloride 2mEq/ml 8,53
64 mEq – 46,93 mEq = 17,06 mEq
17,06 mEq : 2 mEq/ml = 8,53 ml
Magnesium sulfate 4 mEq/ml 16 mEq : 4 mEq/ml 4

Calcium gluconate 10 % (0,465 mEq/ml) 5,5 mEq : 0,465 11,82

Total 54 ml
 Hasil Perbandingan Metode Pump & Pre-set Volume

Hasil Metode
The Pump Pre- set volume
Total TPN volume 2270 ml/day 1135 m//bag  2 bag
Protein volume 429 ml/day 215 ml/bag
Dextrose volume 393 ml/day 197 ml/bag
Fat volume 636 ml/day 318 ml/bag
Electrolyte volume 54 ml/day 27 ml/bag
Sterile water volume to add 2270 ml/day 1135 ml/bag

2270 – 429– 393 – 636 – 54 1135 – 215 – 197 – 318 – 2

= 758 ml/day 7 = 378 ml/bag
Terimakasih