Patient Demographics
Calculated Weight Parameters
IBW
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BMI
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Adj BW
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% IBW
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Dosing Weight
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Clinical Status
Refeeding Syndrome Risk Assessment
The checkboxes below score the NICE CG32 criteria. HIGH RISK: any 1 of Group A criteria, or any 2 of Group B criteria.
For US practice, ASPEN 2020 is the current consensus and its criteria differ — they are listed below for comparison but are not scored by this tool. ASPEN also reviewed NICE's predictive performance directly and found it poor: in a 321-hospitalization review, only ~25% of the 92 patients deemed at risk by NICE criteria developed severe hypophosphatemia during refeeding (sensitivity 50% / specificity 76% for PN; 38% / 73% for NG feeds). Treat a negative NICE result as weak evidence of safety, and cross-check against the ASPEN criteria below.
For US practice, ASPEN 2020 is the current consensus and its criteria differ — they are listed below for comparison but are not scored by this tool. ASPEN also reviewed NICE's predictive performance directly and found it poor: in a 321-hospitalization review, only ~25% of the 92 patients deemed at risk by NICE criteria developed severe hypophosphatemia during refeeding (sensitivity 50% / specificity 76% for PN; 38% / 73% for NG feeds). Treat a negative NICE result as weak evidence of safety, and cross-check against the ASPEN criteria below.
ASPEN 2020 adult risk criteria (US consensus) — reference, not scored
Moderate risk — 2 criteria needed. Significant risk — 1 criterion needed.
| Moderate (need 2) | Significant (need 1) | |
|---|---|---|
| BMI | 16–18.5 kg/m² | <16 kg/m² |
| Weight loss | 5% in 1 month | 7.5% in 3 months or >10% in 6 months |
| Caloric intake | None/negligible for 5–6 days, or <75% of estimated requirement for >7 days during acute illness/injury, or <75% for >1 month | None/negligible for >7 days, or <50% of estimated requirement for >5 days during acute illness/injury, or <50% for >1 month |
| Prefeeding K / Phos / Mg | Minimally low, or normal now with recent low levels needing minimal/single-dose supplementation | Moderately/significantly low, or minimally low/normal now with recent low levels needing significant or multiple-dose supplementation |
| Subcutaneous fat loss | Moderate loss | Severe loss |
| Muscle mass loss | Mild or moderate loss | Severe loss |
| Higher-risk comorbidity | Moderate disease | Severe disease |
Two things NICE has no equivalent for: ASPEN scores physical-exam findings (loss of subcutaneous fat and muscle mass), and it counts recent low electrolytes that have since been corrected. Electrolytes may be normal despite total-body deficiency.
ASPEN's higher-risk conditions (Table 4) include: anorexia nervosa and other eating disorders, chronic alcohol or drug use disorder, AIDS, cancer, malabsorptive states (short bowel, Crohn's, cystic fibrosis, pancreatic insufficiency), postbariatric surgery, hyperemesis gravidarum or protracted vomiting, dysphagia/esophageal dysmotility, prolonged fasting including hunger strikes, refugees, food insecurity and homelessness, failure to thrive including abuse/neglect, major stressors or surgery without nutrition for prolonged periods, advanced neurologic impairment, and protein malnourishment.
ASPEN diagnostic definition of refeeding syndrome (distinct from risk): a decrease in any 1, 2 or 3 of serum phosphorus, potassium and/or magnesium by 10–20% (mild), 20–30% (moderate), or >30% and/or organ dysfunction resulting from such a decrease and/or from thiamin deficiency (severe) — occurring within 5 days of reinitiating or substantially increasing energy provision.
Group A — Any single criterion = HIGH RISK
Group B — Any 2 criteria = HIGH RISK
Not itself one of NICE's listed criteria — flagged here as an independently recognized high-risk clinical picture. Checking this does not count toward the "2 of Group B" NICE-sourced trigger above (a patient with anorexia nervosa severe enough to warrant this flag will typically also meet the BMI/weight-loss criteria directly), but is shown as an advisory regardless of the calculated risk tier.
Basic Metabolic Panel
Electrolytes
⚑ If albumin entered, corrected calcium will be calculated automatically.
Hepatic Panel & Lipid Markers
Baseline Renal Function & Electrolytes
Creatinine and Na/K/Mg/Phos/Ca above drive renal-function assessment and the electrolyte recommendations below. If any are still pending, check the box below to proceed: a missing electrolyte shows "Pending assessment" instead of a dose, and missing age or creatinine means renal function is treated as not assessed.
No Results Yet
Complete patient demographics and labs, then click Calculate TPN.
References
- Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022;46(1):12-41. (Source of the ICU energy range used here: 12–25 kcal/kg/day, lowered from the 2016 guideline's 25–30 — stated in the guideline's own abstract, read directly on PubMed. The full text was not reachable from the verification environment (publisher returned HTTP 403), so the "first 7–10 days of ICU stay" scope and actual-body-weight basis are from secondary summaries only; this tool keeps its usual dosing weight for energy. General calorie/protein dosing ranges and glucose targets. This 2022 update covers 5 specific questions — energy dose, protein dose, PN vs. EN, supplemental PN, and lipid emulsion type — per its own abstract; it does not revisit obesity-specific BMI-stratified dosing, so it is not the source for the obesity numbers below.)
- McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. (Source of the obesity-specific ICU dosing used in this tool: 11-14 kcal/kg actual body weight for BMI 30-50, 22-25 kcal/kg ideal body weight for BMI >50 (a strict >, so BMI exactly 50 sits in the lower tier), and 2-2.5 g/kg IBW protein. The 2022 Compher update above did not re-address this stratification, so these values remain attributed to the 2016 guideline rather than 2022. Also the source, read directly from the full text, of: protein 1.2–2.0 g/kg actual body weight in critical illness (C4) and for trauma (M1a); burns protein 1.5–2 g/kg and indirect calorimetry for burn energy with no weight-based target (M4c, M4b); standard ICU protein for AKI and no protein restriction to delay dialysis (J1, J2); dry or usual weight in hepatic failure (K1).)
- Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1-138. (International guideline, not a US source. Used only for the non-ICU, non-catabolic AKI protein range of 0.8–1.0 g/kg/day (recommendation 3.3.4, read directly), because no current US guideline sets that range.)
- da Silva JSV, Seres DS, Sabino K, et al; Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020;35(2):178-195. doi:10.1002/ncp.10474. (Primary US consensus for refeeding syndrome and the guideline this tool leads with — verified directly from the full published article. Source of: the adult risk criteria in Table 3; the diagnostic definition; and the management recommendations in Table 6 used in the high-risk protocol — thiamin 100 mg before feeding then 100 mg/day for 5–7 days or longer, MVI daily in PN, electrolytes every 12 hours for the first 3 days, vital signs every 4 hours for the first 24 hours, advancement by 33% of goal every 1–2 days, and the 50% calorie/dextrose reduction if electrolytes fall precipitously. ASPEN's initiation range of 100–150 g dextrose or 10–20 kcal/kg over the first 24 hours is disclosed in the protocol but not adopted as this tool's default, which retains the lower NICE ceiling deliberately.)
- National Institute for Health and Care Excellence (NICE). Nutrition support for adults: oral nutrition support,enteral tube feeding and parenteral nutrition. NICE Clinical Guideline CG32, 2006 (updated 2017). (Refeeding syndrome risk criteria. Verified directly against the primary NICE CG32 text on 2026-07-30 — Box 1 and recommendation 1.4.8 were read from nice.org.uk itself and the Group A/B criteria, the extreme-risk definition, the 10 kcal/kg ceiling and the 4–7 day advancement all match. This supersedes an earlier note stating NICE's site was unreachable and that the criteria rested on secondary sources. One presentational difference is deliberate and outcome-neutral: NICE states the Group B thresholds as open-ended (BMI <18.5, weight loss >10%, intake >5 days) whereas this tool shows them as closed bands (16–18.5, 10–15%, 5–10 days). The excluded ranges are exactly the Group A criteria, and a single Group A criterion already triggers HIGH RISK, so no patient's classification can differ. The "history of alcohol misuse, or drugs including insulin, chemotherapy, antacids, or diuretics" Group B item is NICE's own single combined criterion, not two separate ones. "Anorexia nervosa or severe malnutrition" is not one of NICE's listed criteria and is shown as a separate advisory flag rather than counted toward the Group B tally.)
- Default electrolyte ranges (Na 1–2 mEq/kg, K 1–1.5 mEq/kg, Ca 10–15 mEq, Mg 8–16 mEq, Phos 20–40 mmol/day): ASPEN's adult daily PN electrolyte table (A.S.P.E.N. Appropriate Dosing for Parenteral Nutrition, 2019) lists Na 1–2 mEq/kg, K 1–2 mEq/kg, Ca 10–15 mEq, Mg 8–20 mEq, Phos 20–40 mmol. This tool's K upper bound (1.5 mEq/kg) and Mg upper bound (16 mEq) are deliberately narrower than that table. Evidence status: secondary_only — the table was read as reproduced by the Merck Manual Professional Edition ("Basic Adult Daily Requirements for Parenteral Nutrition"); the ASPEN document itself was not accessible (HTTP 404 at nutritioncare.org).
- Peripheral PN osmolarity ceiling of 900 mOsm/L and a maximum dextrose oxidation rate of 5 mg/kg/min: widely cited limits; only the 900 mOsm/L figure is attributed to ASPEN, by Cies & Moore (for the 900 mOsm/L figure see Cies JJ, Moore WS 2nd. Neonatal and pediatric peripheral parenteral nutrition: what is a safe osmolarity? Nutr Clin Pract. 2014;29(1):118-124, a retrospective pediatric cohort study (birth to 21 years) that reports ASPEN's 900 mOsm/L recommendation and found no increase in line-related events above 900 mOsm/L; the Merck Manual Professional Edition, "Parenteral Nutrition", states 900 mOsm/L and a typical maximum dextrose rate of 5 mg/kg/min without attributing either figure). Evidence status: secondary_only — the ASPEN primary statement was not read. Estimated osmolarity here uses a fixed electrolyte placeholder (see warning text).
- Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650-655. (Ideal body weight formula)
- Adjusted body weight for nutritional dosing (IBW + 0.25 × [actual − IBW], triggered at BMI ≥30) — distinct from the 0.4 correction factor used for renal drug dosing elsewhere on this site; both are conventional dosing-weight corrections, not from a single universally-cited source.