The ICU Book by Marino
ICU Book notes tubular epithelial cells and epithelial cell casts is pathognomic for ATN if patient is hypokalemic, get urine lytes and urine potassium if urine potassium <30 mEq/L most likely diarrhea if >30 check U Cl <15=NG drainage or alkalosis >25=diuretics of Mg depletion mg depletion incredibly underdx in icu get art on hypocalcemia in the critically ill (Crit Care Med 1992;20:251) check an occ. phosphate gi sources of sepsis acid suppression leads to gi contamination in upper track source antibiotics cause lower track contamination + urine culture=>10 5th power cfu/cc gram positive organisms in urine in icu-think enterococcus give cipro or vanco+genta TPN Cal = 25 kcal/kg/day Protein=1.4 g/kg/day Take 500 cc 10% Amino Acid Mix and D50 500cc A10-D10 Final concentration is 50G prtotein per liter and 250 G dextrose per liter Volume L per day= Protein gms/50 g/L take the volume amount and multiply by 250 Grams of dextrose=gms/day dextrose g/day x 3.4 kcal/g=Kcal/day given by the A10-D10 Give remainder of calories by lipids lipids =1 kcal/cc come in 50cc dose/units Haldol give 2-10 mg, double dose every 15-20 minutes then give 1/4 of total every q6 hours
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