Electronic parenteral and enteral nutrition

Abstract

Background: With reports of deleterious effects of total parenteral nutrition (TPN) in adults in addition to our surveys, which indicated that 1/4, and as many as 1/2, of US academic medical centers were using excess glucose in TPN, our objective was to devise a computer program to optimize nutrients in parenteral and enteral nutrition in adult and pediatric patients.

Methods: From review of the literature, body composition, including total body water and body cell mass (BCM), were calculated from large published databases. A computer program, based on a previous algorithm, was developed to determine optimum parenteral and enteral nutritional support, based on calculated BCM as the reference. Flexibility to permit any nutrients, in accordance with individual patient requirements, was included.

Results: With entry of simple anthropometric values and an average stress factor equivalent to 20% greater than the Harris-Benedict energy calculation, energy and nutrients were calculated for TPN as follows: amino acids, 3.4 g/kg BCM/d; carbohydrate, 12 g/kg BCM/d; and fat for remaining energy, usually 2.3 g/kg BCM/d. The program, available on any personal computer, is available using Netscape 3.0 or higher or from Microsoft Internet Explorer 4.0, at http://epen.kumc.edu. It permits rapid calculation and display of body composition values, a standardized TPN formula, an alternate TPN prescription, enteral nutrition options, a section that explains the calculations, and a list of references.

Conclusions: The program, http://epen.kumc.edu, provides rapid definition of the TPN or enteral prescription for adult and pediatric patients, with reduced likelihood of providing excessive glucose and energy in parenteral or enteral nutrition.