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The initial TPN prescription is based only on estimates of the patient's kcalorie, protein, and micronutrient needs. The patient's weight, protein, and micronutrient status must be monitored to ensure the prescription's adequacy.

Assessment considerations include:

  • Maximum weight gain in anabolism is 1/4 to 1/2 pound per day. More than that indicates fluid retention.
  • Adjust calcium lab values in hypoalbuminemic patients as follows:

Ionized CA = (measured serum CA) + [4.0 - actual albumin (g/dL)] x 0.8

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