...and my brain HURTS. Today was full of calculating TPN/EN formulas for patients and it included a lot of math! Some of the problems were pretty simple, others were far more complicated. But, I do like being able to see patients and follow up with patients who have been here since last week.
Our ketogenic diet kid (aka: ketokid) left on Saturday. Her ketone levels were a whopping 4.3! So, hopefully that affects her seizures and they'll see a decrease in frequency and intensity. Hopefully the diet isn't too tough to follow though...
and...I'm so happy, but a patient I was following last week who was Failure to Thrive (FTT) and had C.diff (a horrible type of diarrhea bug that is usually contracted in hospitals) has finally started gaining weight. Her projected growth velocity is 25-35 grams per day (she's 16 days old), and between today and yesterday, she gained 85 grams! Hopefully that means she'll be able to go home soon. This is also the patient where when I talked to the mother, she was concerned about the baby's swallowing. Since this is outside of my realm of knowledge, I told her that I'd talk to her physician and suggest a swallowing consult with the speech-language pathologist. And, I paged the doctor and we spoke, and the baby was seen, and insto-facto...the baby gains weight!
It's just really refreshing to have physicians and other healthcare providers really take an RD's (or intern's) recommendations and concerns to heart.
BUT! Back to the math. Anyone wanna give one a try? Here's one of the harder problems I encountered today.
Patient A is on a track to go home. She's currently receiving a solution made from diluted Kids Boost Essential 1.5 to make it a 26kcal/oz solution. How many grams of protein are being injested if the patient is taking in 1500ml? And, if the patient is to get 1560ml of free water per day, how much extra free water must be given? (KBE is normally 45kcal/ml, has 42g pro per liter, and has 720ml of free water per liter)
Haha, give up? Don't worry, it took me a while...
Make it simple: 1500ml of a 26kcal/oz formula using 45kcal/oz formula
- 26kcal/oz x 50oz (1500/30) = 1300 kcal (Finding out how many calories worth come from KBE)
- 1300kcal/45kcal/oz = 28.9oz (Taking calorie info to find ounces used)
- 28.9oz x 30ml/oz = 867ml (Taking ounces used to find volume)
- 867ml solution x 0.042 (42g pro/1000ml) = 36 g of protein (Using volume to find protein!)
If we used 867ml of volume, and there are 720ml of free water for every liter of solution...
.867 (percentage we have of one liter) x 720 = 624ml
If the patient needs 1560ml...(1560 - 624)...they need to get 936ml through an IV or water intake!
As you can see, this is why my brain hurts!! But it's definitely nice to get so much practice. Other than that, today consisted of following up on some other patients, many of who were in surgery or their parents/caregivers weren't available to talk, so there wasn't anything too exciting there. I just worked on case studies and TPN/EN calculations for the majority of the day :)
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