Nutritional Requirements Nutritional Requirements David Ray Velez, MD Table of Contents Estimated Energy Requirement (EER)Macronutrient Requirements Estimated Energy Requirement (EER) Estimated Energy Requirement (EER) Definition: Estimated Daily Calorie RequirementIndirect Calorimetry is Preferred Over EER if AvailableAdult EERHealthy: 20-25 kcal/kg/dCritically Ill: 25-30 kcal/kg/DayEx: Trauma, Surgery, or SepsisBurns: Normal EER + (30 x TBSA)Hypermetabolic State from Elevated CortisolTBSA: Total Burn Surface AreaMorbidly Obese: Decreased Daily RequirementsIf Indirect Calorimetry Available: 60-70% of Target EERBMI 30-50: 11-14 kcal/kg/d for Actual Body WeightBMI > 50: 22-25 kcal/kg/d for Ideal Body WeightPediatric EER< 6 Months: 110-120 kcal/kg/Day6-12 Months: 95-100 kcal/kg/Day1-3 Years: 100 kcal/kg/Day4-6 Years: 90 kcal/kg/Day7-10 Years: 70 kcal/kg/Day11-14 Years: 47-55 kcal/kg/Day15-18 Years: 40-45 kcal/kg/Day Ideal Body Weight (IBW)Males: 106 lb + 6 lb For Each Inch > 5 ftFemales: 100 lb + 5 lb For Each Inch > 5 ft Macronutrient Requirements Acceptable Macronutrient Distribution Ranges (AMDR)Carbohydrates: 45-65% (3-8 g/kg/Day)Fat: 20-35% (0.5-1.5 g/kg/Day)Protein: 10-35% (0.8-1.0 g/kg/Day)Calories Per GramFat: 9 kcal/gProtein: 4 kcal/gOral Carbohydrates: 4 kcal/gDextrose: 3.4 kcal/gProtein Requirements8-1.0 g/kg/Day: Well-Nourished0-1.5 g/kg/Day: Malnourished5-2.0 g/kg/Day: Postoperative Status, Sepsis or Trauma0-2.5 g/kg/Day: Large Burns or ObeseIn Burns: Protein (g/Day) = Normal Requirement + (3 x TBSA)*Decrease Rates in Patients with Renal FailureNitrogen RequirementsGive 1 G Nitrogen Per Every 150 kcalThere are Approximately 6.25 g Protein for Every 1 g of NitrogenNitrogen Requirements (g/Day) = Protein Requirement / 6.25