How many milliliters of water are needed for every 1000 kilocalories in the diet?

Tube feeding analysis tool

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Patient Parameters

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• Summary
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Tube Feed Recommendations

Jevity (1.2 Cal) @ 70 mL/hr

• Start at 20 mL/hr, titrate by 10-20 mL/hr every 4 hours to goal
• 250 mL free water flushes every 4 hours (62.5 mL/hr)

Macronutrients

Fluid

Macronutrient Distribution

Anthropometrics

Jevity (1.2 Cal)

This website is intended to be used in conjunction with reasonable clinical judgment. This is not a substitute for clinical experience and expertise. An electronic tool cannot assess the clinical picture and patient-specific factors.

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About This Calculator

This calculator is not appropriate for the following patient populations, or may require a higher degree of clinical judgment:

• At risk for refeeding syndrome
• Pediatrics

• Concurrent parenteral nutrition
• Special nutritional needs (burns, fistulas, pregnancy)

Determining Caloric Requirements

The ESPEN guidelines for critical care suggest a maximum caloric intake of 20-25 kcal/kg/day during the acute and initial phase of critical illness, but 25-30 kcal/kg/day during the anabolic recovery phase.2 Certain patients (eg, malnourished or morbidly obese) may have different caloric requirements than the standard patient.

Selecting an Appropriate Formulation

The selection of the appropriate tube feed formulation is a very patient-specific decision. The following factors may play a role in choosing a formulation:

• Macronutrient complexity - Polymeric, semi-elemental, or elemental preparations are available depending on the patient's ability to break down, absorb, and tolerate macronutrients.
• Protein content - Some formulas contain a particularly high content of protein, which is often more appropriate for patients in the acute stages of critical illness.
• Volume - Fluid-restricted formulas with a higher caloric density (kcal/mL) are available, but may cause more problems with diarrhea due to high osmolality.
• Disease-specific formulas - Some products are designed for specific disease states, such as ARDS/ALI, hepatic impairment, renal impairment, and diabetes.
• Fiber content - Particularly in patients with feeding-associated diarrhea, increasing the fiber content of a formula may improve tolerability.

For complicated patients, consider consultation with a registered dietitian for recommendations regarding appropriate enteral feeding formulas and supplements.

Considerations for Obesity

In obese patients (>20% ideal weight), this calculator uses a nutritional dosing weight.3 A nutritional dosing weight uses a correction adjustment of 25% (see equation below) to avoid underfeeding (with ideal weight) or overfeeding (with actual weight).

$$\\ Nutritional\;weight = IdealBW + 0.25*(ActualBW - IdealBW)$$

It should be noted that the ASPEN/SCCM guidelines recommend an alternative approach when dosing obese patients.4 According to these guidelines, obese patients (BMI > 30 kg/m2) should receive 11-14 kcal/kg (actual weight) or 22-25 kcal/kg (ideal weight) and protein requirements should be dosed using ideal weight (grade D).

Accuracy of Tube Feed Data

The enteral nutrition products included in this database are the more common formulations from Abbott Nutrition and Nestle Nutrition. The data used is accurate as of February 2013, but may change with time.

References and Additional Reading

1. National Heart, Lung, and Blood Institute (NHLBI). Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks. http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmi_dis.htm. Accessed February 24, 2013.
2. Kreymann KG, Berger MM, Deutz NE, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006;25(2):210-23. PMID 16697087.
3. Krenitsky J. Adjusted body weight, pro: evidence to support the use of adjusted body weight in calculating calorie requirements. Nutr Clin Pract. 2005;20(4):468-73. PMID 16207686.
4. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: SCCM and ASPEN. JPEN J Parenter Enteral Nutr. 2009;33(3):277-316. PMID 19398613.

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