NICUTPN | MedaMeta

Patient's Info
Identification
Gestational Age		weeks
Gestational Age		day/s
Day Of Life		day/s
Corrected GA	—

Patient's Basics
Birth Wt		kg
Current Wt		kg
Wt Change		grams
Urine Output		mL/kg/hr

Access Route
Access Route

BMP			Fluid Management
Sodium			Total Fluids		mL/kg/day
Potassium			Enteral Feeds		mL/day
Chloride			Other Fluids		mL/hr
CO2
BUN			Macronutrients Target
Creatinine			GIR		mg/kg/min
Glucose			AA Target		g/kg/day
			IL Target		g/kg/day

Calcium
Magnesium
Phosphorus

Feeding
Feeding
Calories/oz
Fortifier

Liquids
Total Volume	—	mL/day	Infusion Rate	—	mL/hr

Macronutrients
Dextrose	—	%	Intralipids	—	mL/day
Aminoacids	—	g/day	Intralipid Rate	—	mL/hr

Electrolytes
	Requirement		Absolute amount
Sodium	—	mEq/kg/day	—	mEq/day
Phosphate	—	mM/kg/day	—	mM/day
Chloride	0	mEq/kg/day	0	mEq/day
Acetate	0	mEq/kg/day	0	mEq/day
Potassium	—	mEq/kg/day	—	mEq/day
Phosphate	—	mM/kg/day	—	mM/day
Chloride	0	mEq/kg/day	0	mEq/day
Acetate	0	mEq/kg/day	0	mEq/day
Calcium	0	mg/kg/day
Calcium Gluconate			0	mEq/day

Additives
MgSO4	—	mEq	Zinc	—	µg
MVI	—	mL	Copper	—	µg
Heparin	—	units	Manganese	—	µg

Safety
Osmolarity	—	mOsm/L
Ca/P Solubility	—

Energy
TPN Calories	—	kcal/kg/day	Kcal (Fat)	—	%
			Kcal (Carbs)	—	%
			Kcal (Protein)	—	%
Enteral Calories	—	kcal/kg/day
Total Calories	—	kcal/kg/day