INPUTS
| Patient's Info | ||
|---|---|---|
| Patient ID | ||
| Gestational Age | wk d | |
| Day Of Life | d | |
| Corrected GA | — | |
| Measurements | ||
|---|---|---|
| Birth Wt | g | |
| Current Wt | g | |
| 24h Wt Change | g | |
| Urine Output | mL/kg/hr | |
| Access Route | ||
|---|---|---|
| Access Route |
Central
Peripheral
|
|
| Most Recent Labs | Fluid Management | ||||
|---|---|---|---|---|---|
| Sodium | Total Fluids | mL/kg/day | |||
| Potassium | Enteral Feeds | mL/day | |||
| Chloride | Other Fluids | mL/hr | |||
| CO2 | |||||
| BUN | Macronutrients Target | ||||
| Creatinine | Dextrose | % | |||
| Glucose | Aminoacids | g/kg/day | |||
| Intralipids | g/kg/day | ||||
| Calcium | |||||
| Anion Gap | |||||
| Magnesium | |||||
| Phosphorus | |||||
| Feeding | ||
|---|---|---|
| Feeding |
Breastmilk
Formula
Mix
|
|
| Calories/oz |
20
22
24
26
27
30
|
|
| Fortifier |
None
HMF 22
HMF 24
|
|
OUTPUTS
| Safety | |||||
|---|---|---|---|---|---|
| Osmolarity | — | mOsm/L | |||
| Ca/P Solubility | — | ||||
| Liquids | |||||
|---|---|---|---|---|---|
| Total Volume | — | mL/day | Infusion Rate | — | mL/hr |
| Macronutrients | |||||
|---|---|---|---|---|---|
| GIR | — | mg/kg/min | Intralipids | — | mL/day |
| Aminoacids | — | g/day | Intralipid Rate | — | mL/hr |
| Electrolytes | ||||
|---|---|---|---|---|
| Target (/kg/day) | Total Daily Dose (/day) | |||
| Sodium | — | mEq | — | mEq |
| Phosphate | — | mM | — | mM |
| Chloride | — | mEq | — | mEq |
| Acetate | — | mEq | — | mEq |
| Potassium | — | mEq | — | mEq |
| Phosphate | — | mM | — | mM |
| Chloride | — | mEq | — | mEq |
| Acetate | — | mEq | — | mEq |
| Calcium | — | mg | ||
| Calcium Gluconate | — | mEq | ||
| Additives | |||||
|---|---|---|---|---|---|
| MgSO4 | — | mEq | Zinc | — | µg |
| MVI | — | mL | Copper | — | µg |
| Heparin | — | units | Manganese | — | µg |
| Energy Intake | ||
|---|---|---|
| Source | kcal/d | kcal/kg/d |
| TPN | — | — |
| Enteral | — | — |
| Total | — | — |