[Verified Answer]: To calculate a 2-in-1 solution with a lipid…

To calculate a 2-in-1 solution with a lipid piggyback: 1. Determine patient’s kcals, protein, and fluid needs using a predictive equation. 2. Determine lipid volume and rate for “piggy back” administration. 3. Determine protein. 4. Determine CHO (dextrose). 5. Calculate back and re-check values 6. Check osmolarity (see this after both examples of calculations). Step 1: Example patient needs: 1800 kcals, 88g protein, 2000mls fluid. Step 2: Determine lipid volume and rate for “piggy back” administration. Determine kcals to be supplied from lipid. (Usually 30% of total kcals). Divide lipid kcals by respective kcal/mL. This is the total volume. Divide total volume of lipid by 24 hr to determine rate in mL/hr. Example: 1800 kcal x 30% = 540 kcal from lipid (We can use Lipid (10%1.1 kcal/mL)): 540 kcal/1.1 (kcal/mL) = 491 mL/24 hr = 20.45 (rd to 20mL/hr) since rounding down, calculate back: 20mL x 24hrs= 480 mLs total vol (this will contribute towards fluid needs). Remaining fluid needs: 2000mL-480mL = 1520mL Step 3: Determine protein Subtract volume of lipid from total fluid requirement to determine remaining fluid needs (we did this in the previous step). Divide protein requirement (in grams) by remaining fluid requirement and multiply by 100. This gives you the amino acid concentration in %. Multiply protein requirement in grams x 4 to determine calories from protein