Fluids, Electrolytes, Acid-Base Disorders, and Nutrition Support

Organization

Recommendation

Eastern Association for Surgery of

Trauma (J Trauma. 2004;57:660-669)

22-25 kcal/kg/d for patients with paraplegia

20-22 kcal/kg for patients with quadriplegia

SCCM/ASPEN (JPEN J Parenter

Enteral Nutr. 2016;40:159-211)

25-30 kcal/kg/d or use of indirect calorimetry (lower amounts may be

administered to medical ICU patients with ARDS for the first week)

Obesity: Goal EN regimen should not be > 65%-70% target energy

requirements as measured by indirect calorimetry. For BMI 30-50

kg/m2, a weight-based equation of 11-14 kcal/kg actual body weight/d

is recommended. For BMI > 50 kg/m2, 22-25 kcal/kg ideal body

weight/d is recommended

ASPEN (JPEN J Parenter Enteral Nutr.

2022;46:12-41)

In the first 7-10 days of ICU stay, 12-25 kcal/kg/d (recommended

because of no findings of significant difference in clinical outcomes

between patients with higher vs lower intake; however, this does not

take into account nutrition risk, presence of malnutrition, ICU patient

population [most supporting literature is in medical ICU], or that

most patients receiving EN will receive substantially less than goal

intake during this time because of frequent interruptions to feeding

for ICU care)

ESPEN (Clin Nutr. 2023;42:1671-1689)

20-25 kcal/kg/d (in the absence of measured REE)

aActual body weight is used for all calculations except where otherwise specified.

ARDS = acute respiratory distress syndrome; ASPEN = American Society for Parenteral and Enteral Nutrition; BEE = basal energy expenditure; EN = enteral nutrition;

Predictive methods

Mifflin-St. Jeor equations (preferred for non–ventilator-dependent patients with obesity, AKI or

CKD, or hepatic encephalopathy when a hypocaloric, high-protein regimen is not possible)

Women = (10 x Wt) + (6.25 x Ht) – (5 x Age) − 161*

ii.

Men = (10 x Wt) + (6.25 x Ht) − (5 x Age) + 5*

*Age (years); Ht (centimeters); Wt = actual body weight (kilograms).

Penn State equation (preferred for ventilator-dependent patients with obesity):

REE = (Mifflin x 0.96) + (Tmax x 167) + (Ve x 31) − 6212*

*REE = resting energy expenditure; Tmax = maximum temperature in degrees Celsius; Ve = min-

ute ventilation, liters per minute.

Modified Penn State equation (preferred for ventilator-dependent patients with obesity 60 years or

older

REE = (Mifflin x 0.71) + (Tmax x 85) + (Ve x 64) − 3085*

adult patients)

Women = 655 + (9.6 x Wt) + (1.7 x Ht) − (4.7 x Age)*

ii.

Men = 66 + (13.7 x Wt) + (5 x Ht) − (6.8 x Age)*

*Wt (kilograms), Ht (centimeters), Age (years).