A clinical dietitian’s complete cheat sheet to calculate energy needs

Having a tough time remembering all the calculations for different patient populations or disease states? Look no further. Here’s your cheat sheet for every situation.

Note: These are general recommendations. Use your clinical judgment to adjust for each patient’s individual needs. Use standard fluid calculations, unless otherwise specified.

Abbreviations: REE (resting energy expenditure); EER (estimated energy requirement)

Acute kidney injury (AKI)

Calories: 20 to 30 kcal/kg (100% to 130% REE)

Protein: 

• 0.8 to 1 g/kg if not receiving dialysis, non-catabolic
• 1 to 1.5 g/kg if receiving dialysis
• Up to 1.7 g/kg CRRT and/or hypermetabolic

*Avoid protein restriction with AKI to prevent/delay dialysis; maximum 2.5 g/kg with dialysis

Fluid: 

• Restrict fluid with anuria or oliguria
• No fluid restriction with continuous renal replacement therapy (CRRT)

Breastfeeding

Calories:

First 6 months = EER + 500 – 170 (milk energy output – weight loss)

Second 6 months = EER + 400 – 0 (milk energy output – weight loss)

Protein:  1.3 g/kg

Burns

Calories: indirect calorimetry, if available

Protein: 1.5 to 2 g/kg

Fluid: Parkland formula; urine output goal 0.3 to 0.5 ml/kg/hr for adults

Chronic kidney disease

Calories:

Stage 3 to 5D, hemodialysis, peritoneal dialysis: 25 to 35 kcal/kg

Protein:

Stage 3 to 5:

• Very low protein diet + keto acid analogs: 0.28 to 0.43 g/kg
• Low protein diet non-DM: 0.55 to 0.6 g/kg
• Low protein diet with DM: 0.6 to 0.8 g/kg

Stage 5D, hemodialysis and peritoneal dialysis (with/without diabetes): 1.0 to 1.2 g/kg

*Adjust protein provision based on metabolic stability

Fluid:

Stage 1 to 4: individualized based on comorbidities, physical findings, and alterations in urine output

Stage 5D, hemodialysis: urine output + 1,000 to 1,200 ml

Stage 5D, peritoneal dialysis: maintain fluid balance

Critically ill

Calories:

BMI <30 kg/m²: 25 to 30 kcal/kg

BMI 30 to 50 kg/m²: 11 to 14 kcal/kg of actual weight

BMI >50 kg/m²: 22 to 25 kcal/kg of ideal weight

Protein:

BMI <30 kg/m²: 1.2 to 2 g/kg

BMI 30 to 40 kg/m²: 2 g/kg of ideal weight

BMI >40 kg/m²: 2.5 g/kg of ideal weight

HIV/AIDS

Calories: Harris-Benedict equation, if indirect calorimetry is unavailable

Protein: 1.5 to 1.8 g/kg, if wasting syndrome is present

Liver disease (end-stage, cirrhosis, hepatic encephalopathy)

Calories: indirect calorimetry, if available or REE x 1.2 to 1.4

Protein: 1 to 1.5 g/kg

Pancreatitis, acute

Calories: indirect calorimetry if available, 25 kcal/kg

Protein: 1.5 g/kg

Pregnancy

Calories:

First trimester: EER + 0

Second trimester: EER + 340 kcal

Third trimester: EER + 452 kcal

Protein:

First trimester: unchanged; standard protein recommendations

Second/Third trimester: 1.1 g/kg

Pressure injuries

Calories: 30 to 35 kcal/kg or 35 to 40 kcal/kg for patients losing weight

*Adjust energy based on weight change or level of obesity

Protein: 1.25 to 1.5 g/kg

Fluid: 30 ml/kg or 1 to 1.5 ml/kcal

Surgery (major)

Calories: 30 to 35 kcal/kg

Protein: 1.5 to 2 g/kg

Trauma

Calories: 20 to 35 kcal/kg, depending on stage of trauma

Protein: upper end of 1.2 to 2 g/kg

Psst!

Don’t miss our other resources for acute care dietitians, like the
TPN Troubleshooting Guide and how to get order writing privileges implemented!

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References:

Academy of Nutrition and Dietetics. Nutrition Care Manual. https://www.nutritioncaremanual.org/welcome?.

McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. JPEN. 2016;40(2):159-211.

Mueller CM. The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 3rd ed. 2017.

National Kidney Foundation. Pocket Guide to Nutritional Assessment of the Patient with Kidney Disease. 6th ed.