Parenteral nutrition calculator

1 · Mode

Patient type

Neonatal mode adjusts per-kg calorie target and applies neonatal-CRI dextrose limits (5–8 mg/kg/min target).

Catheter access available

If peripheral only, the calc auto-adds sterile water to dilute final osmolarity ≤ 750 mOsm/L. If central available, no dilution is forced. Unknown just reports the recommended route based on osmolarity.

Compounding path — pick how you'll prepare the bag

Mix from individual stocks Three bottles on the bench: AA + dextrose + lipid. The calc gives you mL of each to add. Use a ready-made premix bag Single multi-chamber commercial bag (Olimel / SmofKabiven / Clinimix). Activate the seals and hang. I already have my volumes Manual entry — type the mL of each component you've already calculated externally.

2 · Patient

Species

Body weight kg

Body condition score (BCS, 1–9)

Drives optional lean-weight prompt at BCS ≥ 7. Default = entered weight (Chan ICU Ch 2 p 9).

Caloric target

Anticipated PN duration

B-vitamins are required in every bag (Chan p 104). Trace elements only at ≥ 10 days.

3 · Recipe target

Pick the comorbidity that best matches the patient. The calc auto-applies the protein tier (g/100 kcal range) and the lipid : dextrose split per Chan ICU. Use the Override recipe panel below if you want to change the auto-applied values.

Comorbidity (auto-sets recipe)

Override recipe manually

Override protein dose g/kg/day

Type a g/kg/day value to override the tier auto-selection. Leave blank to use the comorbidity tier.

Lipid : dextrose split % nonprotein kcal as lipid

Default 50:50 (Chan). Comorbidity preset overrides this — type a number to take manual control. Dextrose share = 100 − lipid %.

4 · Parenteral Nutrition Initiation Schedule

How fast PN is brought up to the full target rate. Slower ramps reduce hyperglycemia and refeeding-syndrome risk. Auto-snaps to Conservative when refeeding screen below is positive.

Schedule

5 · Refeeding-syndrome screen

Chan ICU Ch 16 (Hofer/ESPEN-adapted criteria). Tick any that apply. A positive screen does two things: (1) snaps the PN initiation schedule above to Conservative, and (2) surfaces the pre-PN thiamine/electrolyte protocol below.

Anorexia ≥ 5 days Unintentional weight loss ≥ 10 % over 3–6 months Pre-feeding low or low-normal K⁺, PO₄³⁻, or Mg²⁺ Severely emaciated (BCS ≤ 3 / 9 with moderate-to-severe muscle loss) DKA, prolonged hepatic lipidosis, or severe pancreatitis with prolonged anorexia

6 · Components — mix from individual stocks

For each component, select a commercial product (auto-fills concentration / kcal·mL⁻¹ / osmolarity) or enter values manually. Commercial selection surfaces a verification banner — confirm against the package insert before the recipe commits.

AAAmino acid solution

Product

LLipid emulsion

Product

DDextrose solution

Stock concentration

6 · Premix bag

Pick a multi-chamber premix bag, confirm the label, and the calc returns the bag size, infusion rate, and the delivered protein g/100 kcal versus the protein tier target.

Premix product

6 · Manual recipe

Enter component volumes directly. Calc sums to total volume and weighted osmolarity. Refeeding screen, hyperglycemia/hyperlipidemia, GIR, and additive guards still apply.

AA volume mL/day

AA conc %

AA osm mOsm/L

Lipid volume mL/day

Lipid kcal/mL

Lipid osm mOsm/L

Dextrose volume mL/day

Dextrose kcal/mL

Dextrose osm mOsm/L

7 · Electrolyte additives (KCl + KPO₄)

Optional. Inputs are now in per-kg-per-hour rates (matches IV-K and the phosphate severity table). KPO₄ is incompatible with calcium and magnesium — Chan recommends giving phosphate as a separate infusion rather than mixing into the PN bag (calcium-phosphate precipitation can occur even at apparently safe ratios).

KCl mEq/kg/hr

Stock: KCl 2 mEq/mL. Total daily dose = rate × BW × 24. Adds 4.0 mOsm per mL of stock to the bag.

KPO₄ — pick severity (auto-fills rate)

Per the phosphate severity table. Stock: KPO₄ 3 mmol PO₄ + 4.4 mEq K / mL, 7400 mOsm/L. Dilution 1:20–1:40 for peripheral.

8 · Recipe and final values

Final osmolarity

— mOsm/L

Recommended route

—

Bands per Larsen Ch 45 Table 45.1: ≤750 PPN OK · 750–1100 large peripheral or short central · 1100–1400 CPN preferred · >1400 CPN required.

Macronutrient summary

Macro	g/day	g/kg/day	kcal/day	% kcal	Volume (mL/day)
Protein (AA)	—	—	—	—	—
Lipid	—	—	—	—	—
Dextrose	—	—	—	—	—
Sterile water (auto-dilution)	—	—	—	—	—
Electrolyte additives	—	—	—	—	—

Target RER (kcal/day)—

Caloric target (after tier %)—

Total bag volume (mL/day)—

Hourly infusion rate—

GIR — sanity check (Chan: ≤4 mg/kg/min, human-extrapolated)—

PN initiation schedule

Delivered vs target reconciliation

Reconciliation appears here once inputs are valid.

9 · Safety & guidance

Lab monitoring schedule

Blood glucose — q4h × 24 h, then q6–8h. Target 100–250 mg/dL (Larsen Ch 45 Box 45.2).
K⁺ / PO₄³⁻ / Mg²⁺ — q6h × 24 h (more frequent if refeeding-syndrome screen positive).
Triglycerides — at 24 h, then q24–48h while on lipid (Chan p 110).
CBC + chemistry — at 48 h, then q48–72h.
Ammonia — daily if hepatic dysfunction.

B-vitamins — every PN bag. Per Chan Ch 11 p 104, target per 1 000 kcal of PN: thiamine 0.29 mg / riboflavin 0.63 mg / niacin 3.3 mg / pantothenate 2.9 mg / pyridoxine 0.29 mg / B₁₂ 6 µg. Riboflavin is light-sensitive — add immediately before infusion, deliver in the first 6 h.Chan ICU Ch 11 p 104.

Parenteral Nutrition Calculator