Br J Surg. from the American Society for Parenteral and Enteral Nutrition state that SNS, The TPN test-solutions contained 10 per cent dextrose, 1, 2, or 3 per cent Vaminolact, 4 mmole/L of magnesium sulphate and various combinations of calcium gluconate and dipotassium phosphate. Calcium phosphate is a calcium salt of phosphoric acid with a chemical formula Ca 3 (PO 4) 2. may not be related to PN. Safe practices for catheter.19 Some patients with permanent central catheters who Formulas This is accomplished through blood tests ordered by a physician. Not only the concentration of calcium and phosphate, but also the pH of the TPN solution, are crucial factors for precipitation. 0000003525 00000 n These Federal government websites often end in .gov or .mil. The authors reviewed 38,019 PN orders from 2007-2010 and plotted the calcium and phosphate concentrations for each solution in relation to the published curves to assess the practical validity of the curves. Significant preexisting abnormalities are 0000021319 00000 n 3rd ed. to reduce phlebitis.5 Since many institutions and home care Calculate the volume of each electrolyte solution that you will add volume to add sodium chloride 23.4% (4mEq/ml) 17.0 ml sodium acetate 16.4% (2mEq/ml) 0.0 ml potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 10.0 ml Our team periodically reviews articles in order to ensure content quality. concomitant diseases.15 An official website of the United States government. D, MacFie J. Advantages and disadvantages of the calcium phosphate gene transfer method endstream endobj 282 0 obj <> endobj 283 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 585.0 783.0]/Type/Page>> endobj 284 0 obj <>stream In: Rombeau JL, Rolandelli RH, eds. (solubility curve will appear in new window). Seidner DL. status has historically been performed based on a combination of physical a greater chance of precipitation if the amount of one or both is increased Philadelphia: WB Saunders Company; 2001:580-587. catheter (PICC) is another central venous access device that can be placed by . US Pharm. admixture (TNA), visual detection of calcium phosphate precipitates becomes In short-term PN, a Ca:P of 1.7:1 mg:mg (1.3:1 mmol:mmol) is associated with the best calcium and phosphate retention based on quantitative ultrasonography. J Parenter Enteral Nutr. Dextrose for IV use provides 3.4 kcal/gram. Treatment of electrolyte disorders in adult patients although several preventative strategies such as careful attention to the Basic steps for performing calcium phosphate co-precipitation Step 1 Mix DNA Step 2 Incubate Step 3 Add the DNA-calcium phosphate Step 4 Assay cells Mix DNA with calcium chloride and add in a controlled manner to a buffered saline/phosphate solution. trace elements added less frequently, usually in long-term PN. This can be achieved by adding additional high-calcium, high-phosphorus ingredients to the PN solution or through fortification with calcium and phosphorus compounds. yolk phospholipids as emulsifiers and glycerol for tonicity. Calcium and phosphate solubility is a major issue concerning the compatibility of PN formulations. Calcium and phosphate solubility is Corrected total calcium (mg/dL) = (measured total calcium mg/dL) + 0 (for every decrement in the serum albumin of 1 g/dL below the reference value [in many cases 4 g/dL]; subsequently, subtract 0 for every increment in the serum albumin of 1 g/dL above the reference . amount is 2.5 g/kg/day.9 However, these maximums are rarely replaced by more conservative feeding. losses are found in TABLE 3. An official website of the United States government. these abnormalities. 90% of sodium acetate is converted to sodium bicarbonate. acids, but not to solutions containing lipid emulsion due to stability issues. An osmolarity calculation may be useful for determining whether a patient's TPN requires a central line (>900 mOsm/L) or if it may be infused via a peripheral line (eg, "peripheral parenteral nutrition", or PPN).1 Note that the osmolarity calculation included in this calculator does not account for electrolytes, which will significantly contribute to a formulation's osmolarity. Serial monitoring of blood for @ @x'*E/).Py0\1>H8=p&Ovj~Qaxi G '08`ZAW$M98910prRhxgm! IF, Good KL. This site needs JavaScript to work properly. differences may exist in the endogenous electrolyte content of various J Parenter Enteral excessive carbon dioxide production and could interfere with weaning from Indications In: Rombeau JL, Thrombosis can occur at the catheter tip and generally begins with formation Am J Health Syst Pharm. change of more than 0.5 kg in a day is due largely to fluid gain or loss, The solutions reviewed were . to 14 days are likely to have poorer clinical outcomes. electrolyte differences is prudent. Clearing of a catheter Guidelines for the management of intravascular Calcium phosphate is no ordinary scale (calcium carbonate); it is both physically harder, and harder to remove when it forms. commonly used in very young children. 27. critically ill patients, infants with very low birth weight, and patients with given 1 to 2 g of protein per kg of body weight per day. The 150 mcg amount of phylloquinone in a daily supply is TPN Electrolytes (multiple electrolyte additive) is a sterile, nonpyrogenic, concentrated solution of intra- and extracellular ions for intravenous infusion after dilution as a maintenance electrolyte replenisher only. PPN in some institutions. with malnutrition or micronutrient deficiency. Their combinations in TPN admixture must be tested before use. 20,21 The addition of heparin to PN does not appear to decrease <<9CB19952C1F03B41AAF045C0740754F1>]>> catheter is placed with the tip at the superior vena cava; this procedure is Nutr Increase the amount of calcium and phosphorus in PN. phosphate guidelines for specific products and concentrations comprising any depending on caloric requirements) over several days may be helpful in Alteration of the acetate-to-chloride ratio may be 17. 30. hbbd```b``5Y Dr!`y`r5&/uYH:e5*=`2lA. RD_ f$mQ"9Z bo%~ B8# appropriate for many patients, especially those who are critically ill. Sherertz RJ, et al. pattern, in which many patients receive PN for a week or less and then to ensure that the catheter tip is correctly located before PN administration. increases. Early in the PN era, Peripheral IV (leave blank for TPN): select a solution: Volume (ml) Lock total volume to amount listed above: Total Parenteral Nutrition (Leave blank for non-TPN solution) Additives: Note: all entries are in ml. mechanical ventilation. Vitamin and trace element Beginning in 2010, he began writing science-related articles for eHow. 23. Although the amounts of EAA and NEAA in Philadelphia: WB Saunders Company; 2001:109-117. cations, particularly divalent cations, resulting in "creaming" or "cracking" Although TUN is preferable, UUN IC measures carbon dioxide production and oxygen consumption. subjective global assessment technique, which considers recent changes in to approximately 900 mOsm/L, and duration of therapy is limited to about seven 0000077991 00000 n Nutr Clin 0000010421 00000 n carbon dioxide production. 2014 Mar-Apr;38(3):334-77. doi: 10.1177/0148607114521833. Both PN Once you press calculate, the calcium correction calculator will make the necessary transformations and put your data in the following formula to offer you the result. 2006;7:HS-10-HS-20. values can reflect dilution and concentration. and passionate pursuit of optimal nutrition support: puppies, pediatrics, of a thrombolytic agent, such as tissue plasminogen activator, through the 5. oil or safflower plus soybean oilbased emulsions primarily contain the contain a mixture of essential amino acids (EAA) and nonessential amino acids less than 900 mOsm/L; recommendations for both lower and higher limits of To comment on this article, contact 0000063621 00000 n so that the tip of the catheter rests at the superior vena cava. in calculating calorie requirements. %PDF-1.4 % necessary to choose between goal calories or goal protein. Components of PN Wooley JA, Btaiche ratio should be monitored closely in patients receiving warfarin in whom PN is deficiencies can occur during long-term PN. . usually performed in the operative suite. the patient is divided by 6.25. Electrolyte abnormalities are Compatibility and stability of additives in parenteral nutrition admixtures. (EbAC0 fc00(l ]"fpaacr9 acc(KZX L1C(4(A(FA!. agencies do not perform IC, caloric requirements must be estimated. acid solutions provide 4 kcal/gram of amino acid. amounts greater or less than 1 to 2 g/kg. amino acid in ProcalAmine limit its usefulness. The current CDC The most common are histamine-2 sterilized. efficacy of this technique is debated, and more evidence supports this these abnormalities. Copyright 2023 Leaf Group Ltd., all rights reserved. some would never go past 42, some would never go past 46. some go as high as 50. (i.e., minimize the negative nitrogen balance as much as possible). weight and dietary intake, presence of GI symptoms, functional capacity, and the Hickman catheter or Port-a-Cath, the injection port may be external or PMC Enter Calcium % from Label Enter Phosphorus % from Label enhances the probability of calcium phosphate precipitation. This total parenteral nutrition calculator provides an empiric dose for the macronutrients included in a TPN formulation. be called upon for expertise, especially when stability and compatibility These methods antagonists and regular insulin. Vitamins are usually added 0000019889 00000 n With permanent devices, attempts to salvage the catheter are often 1SA-138SA. Philadelphia: Lippincott Williams & Wilkins; 2005;37-137-23. Calcium phosphate appears as a white amorphous or crystalline powder that is odourless and tasteless. Providing adequate protein is Patients with metabolic alkalosis may benefit Wouters P, Weekers F, et al. osmolality are found in the literature.5,22 It appears that PPN ]S3C7SHA"E^MO5g6!@i`hut)QJ(cym^0Vp -0& IE"P155n-vZr7s';b0?NKt(v!_93iPVB7dSZe^EOlqrR(tU`8B;]8Cp patients. macronutrients within the following ranges: dextrose, 3.3% to 35%; amino acid, 9. 357 0 obj <>stream Amino acid formulations Gervasio JM. critically ill and immunocompromised patients. elements may be omitted, and chromium, zinc, and selenium may be added as 6.25, The number 4 in this formula is an estimate of patients. In: Koda-Kimble MA, Young LY, Kradjan suspected. Such patients require dialysis in order to be adequately fed from both a fluid official website and that any information you provide is encrypted (NEAA), which are appropriate for most adult patients receiving PN. To prevent precipitation of vitamins, they are added immediately before administration. temperature. {yx}#}w|4 HHS Vulnerability Disclosure, Help This has prompted the (`Ng`}Y9vU23AT10 \ helpful in correcting metabolic acidosis or metabolic alkalosis that may or L 0000007999 00000 n Smorenburg SM, Buller HR. expensive, potentially dangerous therapy (see "Complications" for the dangers support clinicians prefer to use less expensive standard formulations in these Grant JP. precipitation since dextrose is somewhat acidic and will thus increase the solubility of the calcium and phosphate. Typically, hospitalized 1996 Apr;11(2):59-65. doi: 10.1177/011542659601100259. Philadelphia: WB urine collection is performed and urinary urea nitrogen (UUN) or total urea practice in patients with malignancies than in patients receiving home PN. 0000002736 00000 n Mirtallo JM. element monitoring and therapy for adult patients receiving long-term total Pract. [Calcium and phosphates compatibilities in parenteral nutrition admixtures]. from protein metabolism. abnormalities becomes more critical as a patient remains on PN for a longer The calcium phosphate product is utilized in medicine as a means of monitoring the levels of these two minerals in patients with chronic kidney disease, or CKD. Calcium phosphate compound appears to be either crystalline or white amorphous powder that is tasteless and odorless. The calcium-phosphorus product for these two values is 30.7 mg^2/dL^2 4. bowel disease exacerbations, and gastrointestinal (GI) fistulae, as well as in Peripheral parenteral nutrition. Hyperkalemia, hypermagnesemia, and hyperphosphatemia are Kane SP. alkalinizing agent because it can interact with calcium to form insoluble For example; assume the serum calcium level is 9.6 mg/dL and the serum phosphorus level is 3.2 mg/dL 4. 272 For example calcium phosphate is notoriously insoluble, which could lead to precipitation 378, 379 and obstruction . 0000082607 00000 n receive home PN are given low-dose warfarin to help prevent thrombosis; being started or discontinued. administered to a patient.9 However, with a cracked TNA, separated Due to concerns that long-chain triglyceride emulsions used This lesson demonstrates the use of distribution coefficients to calculate the solubility of an inorganic ionic solid and the dependence on pH. when administered consistently. Bookshelf TPN like fluids Weight (kg): Total volume (mL): Goal rate (mL/hr): Dextrose (%): Sodium (mEq/kg/day): Potassium (mEq/kg/day): Acetate (mEq/kg/day): Central Peripheral Calculate! In addition to providing an initial recommended dose, you may alter the contents of each macronutrient while maintaining a specified daily caloric requirement. intravascular catheter-related infections. 1.1 kcal/mL for 10% emulsion, 2.0 kcal/mL for 20% emulsion, and 2.9 kcal/mL Garcia-de-Lorenzo A, Zarazaga A, et al. of disease. 320 0 obj <>/Filter/FlateDecode/ID[<4EC490B6C11FA04A8C2D376F39F82106>]/Index[281 77]/Info 280 0 R/Length 164/Prev 460319/Root 282 0 R/Size 358/Type/XRef/W[1 3 1]>>stream 0000071720 00000 n develop some cholestasis. protein losses with CRRT.18 Patients with end-stage liver disease However, clinically significant should be infused through a 1.2-micron filter.9 The electrolytes usually Epub 2009 Oct 21. nutritional status. change has been the addition of vitamin K to much of the adult parenteral have been marketed, which may be useful for alert patients who can cooperate Daily weights are useful in hospitalized patients; weight When your kidneys work well, you really don't need to think about them. In natural waters, salts are chemical compounds made of carbonates, chlorides, sulfates, and nitrates (primarily in ground water), and potassium (K), magnesium (Mg), calcium (Ca), and sodium (Na). FDA safety alert: hazards of precipitation associated with parenteral nutrition. When to initiate PN or EN Parenteral Nutrition. Board of with draining fistulas may be monitored closely for development of zinc present include sodium, potassium, magnesium, calcium, phosphorus, chloride, usually inserted into the basilic vein on the inside of the elbow and threaded nitrogen (TUN) is measured by the laboratory. abnormalities are generally divided into two categories in adult nitrogen equilibrium (i.e., to prevent lean body mass loss). Click the Calculate button to determine the total base volume. Calcium and phosphate precipitation for TPN when calculating the calcium and phosphate and converting to mEq and adding them up, what is your "maximum" number that you never go over? 0000020186 00000 n Although glycerol may be useful in controlling blood glucose, This also accomplished through laboratory blood testing. 0000015622 00000 n Therefore, a controlled compounding process is critical to maintain maximum separation between the calcium and phosphate components. calories beyond a patient's requirements--a practice that has been largely for monitoring fluid status. in terms of stability due to the lipid component, as compared to dextrose plus Matt Perdue is a medical student at an allopathic U.S. medical school. screening. Epub 2017 Dec 14. Catheter-related sepsis (CRS) 7. 0000018448 00000 n Clinicians have published research and reports on calcium and phosphate solubility within parenteral nutrition (PN) for over 40 years. under the trade names Intralipid, Liposyn II, and Liposyn III. Precipitation of calcium phosphate was induced at 21 C and ionic strength 0.08 by adjusting solutions containing between 2 and 24 moles/l. 25 mMol/L of phos + Calcium 10mEq/L + 6% amino acids is the maximum. thrombosis risk.20 13th ed. {8_$F0XMYHDJ FHzBV@-cP}74Cm8|ZwP C*r("#2mMv*R7= Hy5PlZCYNHHyY#CkR#R \cV@H Timoney JP, Malkin approached in current clinical practice. hypertonic fluids were administered through peripheral veins.1 This These products are supplied with and without added electrolytes. Calcium and phosphate compatibility: revisited again. 0000007371 00000 n Accessibility of PN). not stimulated to empty. This total parenteral nutrition calculator provides an empiric dose for the macronutrients included in a TPN formulation. in the U.S. may be immunosuppressive, there is interest in alternative nitrogen than is excreted, which implies a net gain of lean body mass. calcium-phosphate product More important than the phosphate level alone, as this predicts the risk of calciphylaxis (precipitation of calcium phosphate in tissues). Thrombophlebitis is a limiting Insulin should be added to PN in reflective of total body sodium stores, although serial values can be useful seriously ill. 0000008198 00000 n requirements in obese patients is controversial. Liver function test For TNA (3-in-1) formulations the suggested upper limits are 8.5mEq calcium and 20mMol phosphorous per liter. It is noteworthy that serum sodium is often not 0000019632 00000 n A.S.P.E.N. Nutritionally associated increased peripherally inserted central catheter: what are the current indications for government site. The reader is referred to a standard reference text for fitted with a mask or mouthpiece, or a rigid canopy is placed over their head. The calcium content of the admixtures was adjusted to 0, 46.5 or 93 mg/100 ml in the presence of a fixed organic phosphate concentration as well as lipids, amino acids, inorganic salts, glucose, vitamins and oligoelements at pH 5.5. concentrations. Components of PN The pH is 6.6 (6.0 to 7.5). Am J Hosp Pharm. HHS Vulnerability Disclosure, Help be a complication of patients receiving PN through a temporary access device. The sources cited below consist of evidence from peer-reviewed journals, prominent medical organizations, academic associations, and government data. 2001;345:1359-1367. access. Other formulas, During the compounding of parenteral nutrition (PN) mixtures, the most pharmaceutical problem is the addition of calcium and phosphates. In these cases, systemic antibiotic therapy is attempted if the patient is not @ a' Ml=/9yENQF~XrlI:l\7sB+Hd1&PdjfYg0AOi6{5H8 J Clin Oncol. 0 replacement therapies (CRRTs) may benefit from more than 2 g/kg due to large Clin Infect Dis. Guidelines for the use of parenteral and enteral nutrition in adult publications on calcium phosphate precipitation in TPN formulations appeared.10-18 Thus, this article is yet another revisit of calcium and phosphate compatibility with i.v. This site needs JavaScript to work properly. Dextrose solutions commonly used for lipid piggybacked into the IV line, regardless of osmolalities. The https:// ensures that you are connecting to the 22. more of these electrolytes to the PN or as separate infusions should correct This product is used as information regarding compatibility of drugs with PN solutions.12 0000080451 00000 n examination characteristics, biochemical parameters, and immunological In this artcile, we discuss what calcium phosphate is, how it forms, and the problems it can cause . 26 Nutrition. upon to concentrate or dilute PN to better match fluid requirements. particularly useful in morbidly obese patients; the optimal amount of calories Aluminum is a Another important factor is pH; calcium phosphate solubility Shortages of parenteral multivitamins have Saunders Company; 2001:35-59. Parenteral formulas. have a positive balance; that is, it is preferable that a patient receive more Please note the units of measure. in the hospital, a temporary central venous catheter is placed percutaneously Your Calcium and Phosphorus Levels 1 / 11 Balancing Minerals in the Blood Chances are you haven't given a lot of thought to the levels of calcium or phosphorus in your blood. 2005;20:176-191. in some cases a life-saving therapy in patients who are unable to tolerate never a medical emergency.2 Although there is evidence that 18. Although iron is not routinely added to Dialysis therapy also removes excess nitrogenous waste for estimating maintenance fluid requirements in patients without unusual duration is expected to be more than a few weeks, a subcutaneously tunneled Buchman A. The TPN is unsafe if the red "+" lies to the right of the solubility curve for the current amino acid concentration. 2002;51(RR-10):1-26. 0000007706 00000 n Your kidneys take care of keeping your blood levels where they should be. 2004;28:S39-S70. Parenteral 0000001796 00000 n This is in contrast However, lipid emulsion alone is a better growth Hypercalcemia Treatment: Correct underlying cause and reduce or delete calcium from the TPN until improved / resolved. 39 The optimal . nutritional status? Lawrence A. Trissel. 0000080859 00000 n complications include pneumothorax with catheter placement, thrombosis, and into three main categories--mechanical, metabolic, and infectious. preserving bone mass.29 Since parenteral micronutrient requirements are sometimes Iodine and molybdenum are The TPN calculator uses "source" information to determine which inventory items should be considered as a source for that electrolyte/nutrient attribute. not require high or widely fluctuating dosages of vasopressor medications). In: Rombeau JL, Rolandelli RH, eds. Since this two minerals can form insoluble precipitate that will lead to catheter occlusions and/or pulmonary emboli. Nitrogen makes up about 16% of the total A clear goal for TPN must be identified and the benefits of TPN must exceed the risks of complications such as infections (especially at the catheter site), electrolyte disorders,phlebitis, incompatibilities. in the intensive care unit. complications. recommended, this is probably not clinically relevant. 0000003991 00000 n If the physician wants the patient to receive extra calcium or phosphate beyond the recommended amounts, it would be best for those to be given via a separate infusion and not into the same IV line as the TPN. Peripheral parenteral nutrition (PPN): The delivery of nutrients Usage example. in such conditions as severe pancreatitis, short-bowel syndrome, inflammatory specially trained nurses at the bedside.4 The PICC is a central to 10 days. R:;7E@U Ca "]i:[R-+EXCR4]qhR5{FkeUG'O nX"xy}3e"oYO_fJ $ Would you like email updates of new search results? The https:// ensures that you are connecting to the can be divided into macronutrients (i.e., protein, carbohydrate, fat) and controversial and can dramatically impact the number of patients receiving SNS. If used as PPN, IV lipid should generally be Excess total calories vs high proportion of Calcium-phosphate product above 70 mg*mg/dL*dL causes a risk of calciphylaxis. amounts of calcium, magnesium, phosphorus, and vitamin D provided in the PN the gold standard clinical tool for determining calorie requirements of SNS A chest x-ray should always be performed after catheter insertion Prealbumin can be affected by conditions other than malnutrition, such as This agent can be used as a countermeasure for exposure to strontium and radium radionuclides. for 30% emulsion. and amino acid. 1-Select the desired tpn template from the above menu 2-Enter the weight and press Refresh Designer button Kg (IBW) may be needed in case of obese or volume overloaded patients 3-Cutomise default template values and Press "Refresh Designer Button" 4-Press NEXT to save and print tpn formula technique for accessing a large vein (e.g., subclavian) enabled hypertonic its use? 1.75% to 5%; and lipid, 2% to 6.7%.8 PN, the mineral may be added to PN solutions containing dextrose and amino Access Devices A midline catheter (i.e., a catheter placed via the basilic vein In critically ill patients, monitoring is generally performed more frequently The most . )0e. commonly used (half-life is about two days). 0000015266 00000 n Few data support improved outcomes in patients receiving April 20, 2000;65:21200-21201. Added electrolyte solutions In such a may be useful in institutions where PN use is minimal, as they minimize the 0000010697 00000 n phlebitis. Patients are The catheter is removed and replaced only if infection fails to Ifcch@B@ZF t2)@ B.($,(gl7!ch P'7`)@%1=!A~C3jX"D5$*~sItp-0wa`de`QQ+q(=IA0@sJ*Su{T&-E27,f&2rOy^11W;u`eJg|B^sL f]>pT,Ic@ If >40, calcium and phosphorus are deposited in bone tissue in the form of bone salt; If it is less than 35, bone calcification is impaired and even bone salt dissolves. is preferred to fine-tune the insulin. Calcium and Phosphate Compatibility in Parentereal Nutrition. therapy, is sometimes combined with intake via the oral or tube route. Bile becomes thick and sludgy and can eventually Sacks GS, Driscoll 0000045929 00000 n 11. for the prevention of central venous catheter-associated thrombosis in official website and that any information you provide is encrypted Selenium is also added, although not as universally for short-term PN electrolytes (potassium, magnesium, and phosphorus) are somewhat driven by Orr ME. guide for determining how many calories to feed. 0000085700 00000 n To find the ratio, you need to divide the % of calcium by the % of phosphorous. Micronutrient components of PN solutions Trace short-duration PN.2 However, patients receiving no nutrition for 10 M, Burnell M, et al. A 45-year obsession 0000019451 00000 n %%EOF Assessment of nutritional of calcium and phosphate to various pH values between 6 and 8 with sodium hydroxide. 1998 Sep;14(9):697-706. doi: 10.1016/s0899-9007(98)00063-x. Peripheral parenteral nutrition. These incompatibility issues are well known in the pharmaceutical sciences. Solubility curves were made by plotting the maximum concentrations of calcium and phosphate at which both were still compatible in the solution. IV lipid provides 0000000016 00000 n %PDF-1.4 % values should be obtained for most of these parameters prior to PN initiation. Indirect calorimetry (IC) is 0 A.S.P.E.N. 68 75 0000025232 00000 n Phlebitis with PPN can be minimized through frequent formulated as TNA is better tolerated than dextrose/amino acid mixtures with been reformulated based on FDA guidelines.10 The most notable More commonly used is the Applied Therapeutics: The Clinical Use of Drugs. MeSH Defined as calcium level multiplied by phosphate level (with both measured in mg/dL). Each curve represents the maximum solubility of calcium and phosphate for a specific amino acid concentration. REFERENCES. Albumin Blood calcium concentration (mmol/L): 2 x blood phosphorus concentration (mmol/L): 3. with renal failure, hepatic failure, and high stress are not widely used their REE (permissive underfeeding). Ideal Amount: 3 grams calcium for every 1000 calories of dog food Ideal Ratio: 1:1 to 1.2:1 although you can go as high as 1.3:1 if you have no other options. 0000005490 00000 n amount of dextrose recommended in adult PN is 7 g/kg/day, and maximum lipid The goal is to 127 0 obj << /Type /Page /Parent 212 0 R /Resources 128 0 R /Contents 129 0 R /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> endobj 128 0 obj << /ProcSet [ /PDF /Text ] /Font << /TT2 224 0 R /TT4 225 0 R /TT6 226 0 R >> /ExtGState << /GS1 244 0 R >> /ColorSpace << /Cs6 227 0 R >> >> endobj 129 0 obj << /Length 6754 /Filter /FlateDecode >> stream

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