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NastyGal reviewsIs this your business?
Los Angeles, CA 90027
Tel: (855) 627-8942
541 Reviews From Our Community
All Reviews
Paid £10 for next day delivery, did not arrive on the day it was supposed to. I then missed parcel as they sent me the delivery slot 10 minutes before it arrived the following day, so was not home (hence why I paid for next day delivery, as knew I would not be in that day). They would not refund me next day delivery charge even though it was sent off a day late which was confirmed in the tracking section, therefore false advertising on "next day delivery" part. Now I have to wait till next working day and the event I have is on the weekend. So disappointed. Can not rely on their delivery and have missed out on a nice outfit for my event because of it - and NO REFUND.
love love love my clothes! They look so good on! The nasty gal team stayed in touch with me the whole time even when I couldn't access the tracking number! I did have to go to the postal office to pick up my package because no one was there to sign for it, however nasty gal sent my package in a timely fashion and for what I paid the clothes are amazing quality! Recommend! I'm a first time buyer and will be back for me
I order from them and had a lots of problem with the delivery system. This was not directly their fault but anyways they didn't seem helpful at all telling me to pick it up from a postal office when I had payed for the delivery. Bad service and response. Never got my order and the refund is still in process.
DO NOT BELIEVE THE 5 STAR CUSTOMER REVIEWS THAT YOU SEE BELOW. These are all reviews that the Nastygal commitee posted to salvage the situation of their bad service, bad delivery and overall bad crisis management handling.
(TLDR: Scroll to the bottom for the concluding point that can be explained by the paragraphs below)
Ordered a parcel on the 16th of December. It was projected to arrive between 5-14 working days and was shown via tracking to have been on its way and already left the warehouse. 3 weeks later, my parcel still had not arrived. Emailed Nastygal and a member of the service staff told me that my parcel was delayed and held up at customs and would reach me by 17 January. On 13 January, I gather that they could not handle the situation anymore, they emailed me telling me that my request for a full refund had been approved. I HAD NOT REQUESTED A FULL REFUND AT ALL. They also included in the email that a refund might have been processed because the clothing items that I ordered were out of stock. The question here is how could my items have been delayed if they were already shown to have been shipped out at customs.
Wrote an email to clarify, and a member of the staff gave me the response that a full refund should suffice for the trouble caused in the episode. Pressed on further for an explanation and they told me that the courier had delivered it to the wrong address, thus the items had to be returned. They still refused to give me further compensation except for a refund (which was obviously what I was entitled to since my items had been 'returned'). I wrote another email back to tell them that I had checked with my account information and the address was accurate and there was no way that the courier had delivered it to the wrong address. This time, the staff said that she had checked and the courier had indeed delivered it to the correct address, and that the problem had occurred at "the delivery stage". It was an appalling experience with Nastygal, given the amount of offhanded excuses they gave to me regarding the whereabouts of my parcel, and even so, they still refused to give me further compensation except for the full refund which is actually not even a compensation in any way because my items were forcibly 'returned'.
In addition, I told them that I was willing to let the matter go if they would just ship my original order back to me, to the correct address but they gave me an excuse that because the refund had been processed, they would be unable to ship it to me. To me, it just sounds like a convenient way to explain away their inability to proceed with my shipment because their warehouse had run out of sizes for what I had ordered in the first place. I say this because when I tried to reorder my items, most of the items that I had originally ordered are out of stock or they do not have it in the size that I wanted anymore. This should most likely not be the case, especially since my items had been returned to the warehouse. In any case, I will be checking my credit card statement to make sure that I have gotten a refund for both the delivery charges and the full price of the items. In addition, future customers should take note that the website refunds you the exact value of the items that you ordered and does not make use of your overlooking of the difference in currency between pounds (£) and dollars ($) to make a slight profit for themselves at your expense.
To sum up my experience, Nastygal is FULL OF LIES, possibly being a Ponzi Scheme of 2019. My guess is that:
The items that I had ordered had never left the warehouse in the first place because they did not have stock for the items. The tracking shown on the parcel is fake and used to temporarily satisfy customers. Upon realising that our parcels are delayed, we are given another temporary gratification in knowing that our delivery charges have been waived and that the parcel is on the way. However, close to the due date, a refund is off handedly 'forced' upon us, making us wonder what went wrong. After that, stupid excuses such as the parcel being sent to the wrong address are given to us, with the company pushing away all blame onto the courier and the fact that they have given us a full refund, to eradicate themselves of all blame. A few questions remain. Did my items actually really get shipped out of the warehouse? Also, more importantly, IS THE COMPANY PROFITTING FROM THE IGNORANCE/LAZINESS OF US CUSTOMERS? It was only upon greater reflection that I realised that I should double check my credit card statement to make sure that I had not only gotten back a refund with the right amount, but also in the right currency. In conclusion, do not order from Nastygal.
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After reading other reviews and seeing that the same thing happened to me I decided to post a review and a possible suspicion. I ordered three items around 150 or so Canadian collars months ago; I was wondering where it was so I emailed them. They said it appeared my items were lost and they would reorder them and send it with the possible fastest shipping for free. I said sure, well another month and a half goes by and I hear nothing. I get an email this morning saying my account will be refunded as the items were lost. Again!?? And why didn't you bother telling me that. Hopefully I get the refund...seems like they take our money, use it, then skate by with mailing people damaged goods, doesn't match the picture, only 2 out of 9 items etc, to refund our money with no viable explanation months later. Ponzi scheme anyone????!!!!
I bought a slippers to wear to New Years eve party. Which I had to send to USA and then shipped to Jamaica. It is very expensive to get stuff to Jamaica but we always foot the cost/ chargers. Anyways, when I got my order a size 7/40 slippers was sent to me instead of the size 9 I ordered. When I contacted the company they insisted that it was a size 9. I want to know wear in the world is China size 7 shoes a size 9. The person that answered me in Instagram was not helpful and in fact was very rude. Poor poor customer service. Do not and I repeat do not order any shoes from Nasty Gyal. My issue was not resolved I had to take the loss.
Tip for consumers: Do not shop shoes from Nasty Gyal
This company is a literal fraud. They do not even sell their own products, but products from some aliexpress-like/ no-name-like companies. They photoshop photos of the products and say they are ''NastyGal best quality''. I have ordered black faux leather heeled boots from them. Boots have arrived quite quickly to Europe. But I have received them in a ripped and tied with a rubber band box from a brand called Krush since 1970. I tried to find any info about this brand but I found only 2 eBay Krush since 1970 auctions among the whole Internet. The shoes were supposed to be ''best quality faux leather'', but they are actually made from a stiff, matte, cardboard-like material. The heels are foamy and seem like they are about to come off the shoe. The ''leather'' has white wrinkles. I wanted to try the shoes on but my feet couldn't even go through this inflexible material! It took me hours to put them on and then to take them off! The shoes had a price of good quality shoes from a legitimate brand, but I got some semi-product from a ghost brand instead. And I have wasted my money. I heard that Nasty Gal customer service is pitiable so I decided to keep those shoes and see if they would actually work. Stupid me. The first day I went out in those shoes, the sole of one of them came off. I can say nothing but SCAM
Hi where is my dresses? No cs answer my calls or email. Nothing! I wish this business close very soon! Totally BS! They are LIAR!
I ordered 3 packages 3 weeks ago. Should have arrived after 6 days but when i asked costumer service were it was i just got 3 confirmation-emails that they had received my 3 returned packages! Both me and my friend got this mail and we have NOT received anything. Should have known their crazy sales was too good to be true! Would have given a minus amount of stars if i could!
Tip for consumers: Dont
I, like many others apparently, had never ordered from Nastygal but had previously heard that the quality of their clothes was good. So, when I got an email on black Friday that the whole site was 60% off, I was a little blown away. I ended up placing two orders (some items for myself, some as gifts for my roommate) and it was a little slow. When I got the shipping notifications, the shipper was "royal mail" or something and when I clicked the tracking links the royal mail site said they couldn't find my package at that time, and it couldn't find it even after it was delivered to me. I ordered a shirt, a shirt dress (both very boxy and unflattering on me, but these were gifts so I didn't return them), earrings that were decent enough, a bodysuit (cheap plastic clasps at the crotch kept coming undone and there were strings everywhere showing how cheap the sowing was but didn't look too bad on) and a sherpa-esque jacket which wasn't that bad.
The quality wasn't poor enough to scare me away given the "60% off" pricing and the pictures and styles are appealing, but I don't think I will be ordering from them again.
I spent over 300$ and its a total waste. AVOID NASTY GAL. Poor poor quality and they make you pay 15$ for a 6 business day shipping... I waited over two weeks and Im still waiting for some items. NEVER AGAIN. Its a steal.
I was apprehensive to buy from them after reading these reviews along with similar websites. However, I will say, I am not unimpressed with my purchases!
Although I do agree on the front that the pictures are slightly misleading, for being fast fashion, I would say the clothing is pretty high quality for the price you are paying. The only problem I had was that I bought a pair of platform shoes and then ended up being way taller/ more goth looking than I anticipated.
The customer service reps are extremely kind and helpful, and I will definitely be doing business with them again :)
If I could give it zero stars i would. I had been in contact with customer service via Instagram (they don't have a phone number) because I placed an order over 2 weeks ago. After the 21st, I stopped recieving shipping notifications. Customer service kept telling me to allow one more day, one more week, etc. Finally yesterday I contacted them a 4th time and they replied saying my order had been refunded. I did not ask for a refund. I just wanted to know the status of my order, I didn't mind waiting. They replied that apparently my package had been lost. If that was the case, I'm sure USPS would have been in contact with me. They said my money would be back in my account by the 7th. Hate to say it but I'm doubting I'll even be refunded. Truly disappointed with this company. I knew their sales were too good to be true. And their customer service dept. was completely illiterate, clearly from a place that does not speak English, even though apparently this company is UK based. I don't know what happened to this company it used to be great but now it is a scam.
I bought two items, bodysuit and a dress, I have never seen such a poor made pieces of clothing. But, the dress is an absolute disaster, it has no fit, and looks really ugly. I felt bad that I have let myself fall for Nasty Gal's sale. I used to order clothes from them all the time about 4 years ago, and it was great, I mean one of the best. Now, its an absolute worst. From a quality of fabric to a customer service to a delivery - everything struggles. I hope they will stop selling soon, as producing such a garbage is not good for customers nor for the environment. Avoid Nasty Gal, I know the sale price looks attractive, but its not worth it.
You have to wonder why cheap-and-NastyGal even exists. Terrible quality, over priced, and actually pretty ugly, sorry. I ordered 9 items, only received 2. The straw clutch is not the same product shown on the website - whats the deal with that? See the photo I attached. Nasty Gal sells this bag for $40 and then sends you something different. How is that acceptable? Ordered a sequin top (valued $40, got it 50% off) tried it on once, there are now sequins all over the floor. I still can't believe I paid 20 whole dollars for it. Cant comment on the other 7 items that are missing. This company and its products are a mess, avoid!! There are plenty of other cheap stores that offer cute clothes, stick with them.
I got my very first order from @nastygal this morning and one of my three items was missing and another was damaged( basically coming apart but I figured I can fix this so no big deal). I reached out and asked for my missing item to be sent out. They initially said no and that I would get a refund in 8 days and then have to wait a further 7 days for it to be processed,I was confused because I could see it was available on the website but they wouldn't send me the item missing from my order. I asked if I could speak to a manager but got no call ( I was told I would get one). After going back and forth I was finally told I would be sent one voucher for me to purchase my item again and another of 5 for the damaged item. Firstly I didn't receive the voucher to replace the missing item and when I went to the website the item was FOUR times the original price ( Yes FOUR times) so their voucher wouldn't even cover it. I went back to them about both not receiving the voucher and the new price and was told It was an issue with the website and it would be adjusted so I could make my purchase again. The next person who contacted me told me I just had to repurchase the item at the new price ( AGAIN 4 times the price for an item I already bought but just didn't get). As if this isn't enough, I did receive the 5 voucher for the damaged item but get this it was a boohoo.com voucher Actually blown away by how awful the customer service is.
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I brought 4 different pairs of shoes at a US size nine. The shoes were small, and the one flat pair of miles had one shoe that was too small, while the other fit fine. Upon reporting this to customer service, they kept reinstating that I had to ship it back and use the original packaging. First of all, the package was sent in a plastic bag..You can't reuse that after ordering, and I believe the size variation was an issue because it came from the UK. I am beyond disgusted that they couldn't assist, even with the one distorted shoe, and it is my responsibility to find packaging and send it back. I've received better customer services for hair products..let alone shoes!! I will stick with DSW where sizes are real, and service is better.
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So I've ordered from Nastygal quite a few times. I'm always a little hesitant since the reviews are always quite bad but in my experience I've never had much of a problem. I've always received my things in a reasonable amount of time and I think I may have had to contact their customer service a few times for things but have always been helped. The return process was straightforward and I've been credited back just fine. I may have just gotten lucky with my purchases but no major complaints. *shrugs*
I had never bought from Nasty Gal before, but based on what I had heard for the past few years, they had really nice stuff. They had a 50% off sale, so I decided to go crazy. I bought 13 items and everything was very reasonably priced - I only paid about $150. However, I should've known better, because the quality was absolutely horrific. None of the items looked as good as they did online, from horrible thin nylon fabric to sweaters that were literally made out of felt for $15. Sizing was inconsistent, details were sloppy and somehow hems were uneven. I would never order from them again, even if they were handing clothes out for free. I have never seen clothes that looked so cheap on, not even when I ordered from Boohoo, which is apparently their parent company now. It makes sense that their quality as dropped so much. However, their customer service was alright. When I emailed them, the replied the next day. Couldn't help me of course, but were still fast. I honestly have never been this disappointed with an online order, and I will already be returning all of the items I purchased within a day of receiving them.
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I ordered the "Top of the World Platform Chelsea Boot" they had 50% off so I though I would go for it expecting them to be a great buy for the price ($40 dlls plus shipping, when they were originally 80dlls) ... WRONG. The boots came in 3 days late. They are the cheapest quality EVER. The heel was a super cheap foami material and it was all scratched and turned white where it had been scratched (notice that the heel was supposed to be black)
They came in a size UK 36, when I specifically ordered them in a US 5. They came in with black pen-tint-like-stains in the white areas. Honestly the worst buy I have made by far from nasty gal. Worst experience ever. Definitely returning them.
I bought some shoes off this store about $50 and some accessories, thinking they were good quality for the price. When the package arrived it was covered in dirt and grime! On the inside! I also found the an address sticker for someone else, I'm guessing that person returned the item and they sent it to me, yuck.
I didn't want to go to the hassle of dealing with the filthy item, I just ending it up throwing it away.
You're really living up your name Nasty.
** I never got a refund since I threw it away, this is just an honest review on my experience with the company.
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I ordered three items from them a month in advance for this event I had coming up. Shipping was taking much longer than usual and the tracking said it had already been in the same city as me for 5 days. It took me forever to get through to usps for the problem since nastygal would not do the research for me, and when I finally did they told me the senders (nasty gal) had put in my address all wrong and it would never get to me unless they fixed it. So moral of the story, I never got my items which I was really looking forward to, and had to figure it out all on my own. I'm glad I got a full refund, but I would have muched rather just received the clothes.
I received my order yesterday (which came late). And in my large order i received "Such a Square Bodysuit".
Not only did it have a hole in the front. I went to try it on an the crotch had a yellowish stain on it and i went to sniff because i was like "surely not" and to my HORROR it smelt like someone had 100% worn this before me. This Was clearly someone else's return - where NG obviously didn't check before they sent it on to the next person. Not only is this totally disgusting but it's completely unhygienic!!!!! I feel disgusted and blown away that they would think this was acceptable to send this to someone.
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The quality of these clothes are absolutely abhorrent. DO NOT ORDER FROM NASTY GAL!!!!!!! Never ever again.
I ordered 2 things- a crop top (size 2) and thigh highs (size 7). They sent me a size 6 crop top and a size 5 thigh highs. How do you mess up by two sizes and both the items I ordered at that?! First time, and last time I will ever order from here.
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Customer Questions & Answers
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I never ordered Anything from this company, they got my debt card # and just started to Take funds out of my acc. That is how they got caught, I would NEVER order anything from them!! Be very careful if you do.
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Hi!! I had to order 2 sizes up...these clothes are made for slim petite women. If u are not then order at least one size up.
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A: Try tweeting at @Nastygal, @Nastygalhelp, and #Nastygal with your issue and that no one is responding. Also, everyone should file complaints with the Better Business Bureau and FTC!!!!
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This place is a big rip off ! Buyer beware!!!
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Go on to. Their customer services and there is a Q and A box, write to them and see. I also received a reply within a couple of days and the sent me one of the items that was missing and resent me one of the items that was damaged ( tiny hole) and didn't even ask me to send the damaged one back! Be careful sizes are smaller than ours. Good luck but I received good service....
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Try tweeting at @Nastygal, @Nastygalhelp, and #Nastygal with your issue and that no one is responding. I finally got a response and my same issue has been "escalated". You have to be firm (and polite) but I was clear I would not accept this "sorry -- nothing we can do" answer. Look for ANY record you may have (order number, email,etc). Also, everyone should file complaints with the Better Business Bureau and FTC!!!!
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OH WOW! That sounds sooooo bizarre! But, I've order at least 10 times from Nasty Gal and I never heard of something like that... Sadly, it might have been like a return item that slipped through the cracks and was sent back out :( But, hey, I'm sure it was just a random fluke.
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What's New for February 2019
WHAT'S NEW FOR FEBRUARY 2019 For readers of historical or period fiction, the Library has The Queen of the Night by Alexander Chee. Set during the time of Second Empire Paris (mid 1800s), this novel features romance and political intrigue as the main character transforms from a circus performer to…
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A Stranger in My Own Country
'I lived the same life as everyone else, the life ofordinary people, the masses.' Sitting in a prison cell in theautumn of 1944, Hans Fallada sums up his life under the NationalSocialist dictatorship, the time of 'inwardemigration'. Under conditions of close confinement, inconstant fear of discovery, he writes himself free from thenightmare of the Nazi years. His frank and sometimes provocativememoirs were thought for many years to have been lost. They arepublished here in English for the first time. The confessional mode did not come naturally to Fallada the writerof fiction, but in the mental and emotional distress of 1944,self-reflection became a survival strategy. In the 'house ofthe dead' he exacts his political revenge on paper. 'Iknow that I am crazy. I'm risking not only my own life,I'm also risking ... the lives of many of the people I amwriting about', he notes, driven by the compulsion to write.And write he does - about spying and denunciation, about thethreat to his livelihood and his literary work, about the fate ofmany friends and contemporaries such as Ernst Rowohlt and EmilJannings. To conceal his intentions and to save paper, he usesabbreviations. His notes, constantly exposed to the gaze of theprison warders, become a kind of secret code. He finally succeedsin smuggling the manuscript out of the prison, although it remainedunpublished for half a century. These revealing memoirs by one of the best-known German writers ofthe 20th century will be of great interest to all readers of modernliterature. Hans Fallada was born in Greifswald, Germany, on 21 July 1893 asRudolf Wilhelm Adolf Ditzen; he took his pen name from a BrothersGrimm fairy tale. He died from an overdose of morphine on 5February 1947 in Berlin. Fallada was the author of many bestsellingnovels including Little Man - What Now? (1932), WolfAmong Wolves (1938) and Every Man Dies Alone (1947).
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I've been pleased with the King Arthur Flour chocolate pizzelle recipe,
I make it pretty much as-is, though I drop the butter down to 85g.
Trying to change things around I've made variations on the flavors. I've made strawberry pizzelles using freeze-dried strawberries, blended into a powder and substituted for the cocoa powder in the same amount (21g) and it turned out nicely. Oddly, I also tried it with freeze-dried raspberries, but they didn't taste very raspberryish.
By happenstance the bags of freeze-dried berries are exactly 42 grams, so I have another 21g of raspberry to use, but I want the berry taste to be stronger. My thought had been to substitute some raspberry jam for some of the sugar (198g/1 cup). I'm not worried about reducing sweetness but about consistency. Can I get away with about 1/4 cup of raspberry jam in place of 1/4 cup sugar? 1/3 to 1/3 cup? Or would the ratios be different because of their different consistencies?


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CHATTER INSTAGRAM PAGEVisit the Comet Stop and your money goes toward prom!Comets vs Clifton Central. Senior Night for Boys Basketball and Cheerleading. Congratulations and good luck to all our seniors! February 11, 2019The Academic Challenge Team competed in the regional event on Feb. 5th at Kankakee Community College. 3rd place medals: Nathan Minuth in Physics; T.J. Sforza in Math and English. 2nd place medals: Luke Johnson in Computer Science; Klayton Schott in Physics. 1st place medals: Meghan Davis in Physics; Justin Read in Engineering Graphics. Overall the team earned 3rd place and those individuals who placed in 1st and 2nd place will compete in the sectional competition in March!Congratulations to the Speech team members who qualified today for the IHSA Sectional next Saturday: Annika Marchi in Dramatic Interpretation; Alexa Cieslak in Poetry Reading and our Performance in the Round group.


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Margel Camille Luy-Galagar
Parenteral nutrition is administered outside the
digestive tract, intravenously. This is in contrast to
enteral nutrition, which encompasses oral and
tube feedings into the digestive tract.
The general rule of thumb for deciding whether to
use parenteral or enteral feeding, is "if the gut
works, use it". The GI tract should be used if
possible because it tends to atrophy when not
used. Gut bacteria can translocate to the
circulatory system through an atrophied GI tract
and increase the risk of infection.
Peripheral Parenteral
With peripheral parenteral nutrition (PPN)
nutrients are supplied via a peripheral
vein, usually a vein in the arm. Another
term for PPN is peripheral venous
nutrition (PVN)
Hypertonic Solutions
Peripheral parenteral nutrition feedings usually
supplement enteral feedings. Large amounts of
nutrients cannot be supplied via a peripheral
vein, because these relatively small veins
cannot tolerate the rush of fluid into the vein
that occurs when a hypertonic solution is
introduced into the circulatory system.
Body fluids have an osmolarity of about 300
mOsm. The introduction of a hypertonic
solution into a body compartment will cause an
osmotic gradient, resulting in a fluid shift.
Hypertonic- having a higher osmolality
than the comparison solution.
osmotic gradient- solutions on either side
of a semipermeable membrane.
Osmolarity- The osmolarity of a PPN
solution is an important consideration in
PN solutions. Osmolarity is the number of
dissolved molecules and ions per liter of a
It may be easier to think of osmolarity as the
number of particles per liter of water.
Hypertonic Solutions
When a hypertonic solution is introduced into a
small vein with a low blood flow, fluid from the
surrounding tissue moves into the vein due to
osmosis. The area can become inflamed, and
thrombosis can occur.
A hypertonic PN solution results in an osmotic
gradient that causes water to enter the blood
vessel, as is illustrated in the picture, where
high concentrations of glucose (green) and
amino acids (yellow) draw water (blue) into a
blood vessel (red).
Osmolarity of
Protein and carbohydrate both contribute
to hypertonicity. Fat is isotonic, and can
therefore be administered peripherally.
However, if the patient has delayed lipid
clearance, the use of lipids is
Infusion of Peripheral
In peripheral PN, the catheter is inserted
into the arm vein of the patient. Up to
1800-2500 kcal and 90g protein can be
supplied via peripheral parenteral
nutrition. However, this relatively high
kcalorie/protein amount can be
supported peripherally only for a short
period of time.
Recommended Rates
IBW Infusion rate (cc/hr)
40 60-80
50 75-100
70 100-140
80 120-160
90 130-170
Total Parenteral
Total parenteral nutrition (TPN) is
sometimes called central parenteral
nutrition (CPN) or "hyperal"
Hypertonic Solutions
Large amounts of nutrients in a hypertonic
solution can be supplied via TPN. The catheter
is surgically placed into the superior vena cava.
The reason that larger amounts of nutrients in
a hypertonic solution can be supplied via the
superior vena cava than with peripheral
parenteral nutrition is that the superior vena
cava has a much larger diameter and a higher
blood flow rate, both of which serve to quickly
dilute the TPN solution.
Amino Acid Solutions
Protein is provided as a crystalline amino acid
solution. 500 ml bottles are standard.
Solutions vary in amino acid concentration and
amino acid composition. The patient's protein
needs determine the protein concentration to
use, and the underlying disease state
determines the composition of amino acids to
Amino acid (AA) % solution AA content
solutions are (g/100ml)
generally available in 3.0% 3.0
the following
concentrations: 3.5% 3.5
5.0% 5.0
7.0% 7.0
8.5% 8.5
10.0% 10.0
Uses of Amino Acids
Although amino acids have 4 kcalories
per gram, they do not normally contribute
to the kcalorie requirement of the patient.
Instead of being used for energy, amino
acids should be used for protein
synthesis. Typically, to determine protein
needs, a nonprotein kcalorie to nitrogen
ratio of 80:1 to 150:1 is used.
Nonprotein kcal:N ratio
80:1 the most severely stressed
100:1 severely stressed patients
150:1 unstressed patient
Dextrose Solutions
Dextrose in solution has 3.4 kcalories per
gram rather than 4 kcalories per gram as
in dietary carbohydrates, because a
noncaloric water molecule is attached to
dextrose molecules. Dextrose solutions
come in different concentrations, and the
solution is abbreviated D(%solution)W.
For example, D50W indicates a 50%
dextrose in water solution.
Infusion Rate of
Dextrose solutions should not be administered at
a rate higher than 0.36g per kg body weight/hour.
This is the maximum oxidation rate of glucose.
Excess glucose is converted to fat, which can
result in fatty liver. In addition, the conversion of
carbohydrate to fat can cause excess CO2
production, which is undesirable for patients with
respiratory problems.
Example maximum dextrose calculation
60 kg patient:
Dextrose infusion should not be greater than .
0.36 x 60 kg x 24 hr
= 518 grams per day
Practice Calculation:
70 kg=_______g
80 kg=_______g
90 kg=_______g
100 kg=______g
Lipid Emulsions
Lipids in parenteral nutrition are used as a
source of essential fatty acids (EFA) and
energy. Lipid emulsions are composed of
soybean and/or safflower oil, glycerol, and egg
Approximately 4% of total kcaloric intake
should be EFAs to prevent EFA deficiency.
Since IV lipids are isotonic and calorically
dense, they are a good source of
kcalories for hypermetabolic patients, or
patients with volume or carbohydrate
restrictions. Lipids can provide up to 60%
of non-protein calories.
Essential Fatty Acids
Before lipids could be administered
intravenously, essential fatty acids were
provided by rubbing vegetable oil into the
patient's skin. Today, however, the efficacy of
this procedure is controversial, but it might be
used in the case of patients who cannot
tolerate a lipid emulsion.
Lipid Emulsion
IV lipids come in bottles of 10% or 20%
emulsions. The 10%
emulsion contains 1.1 kcal/ml the 20%
emulsion contains 2 kcal/ml.
Bottles come in the following volumes -
100 ml, 200 ml, 250 ml or 500 ml.
500 ml of 10% lipids given once or twice
a week is generally enough to prevent
essential fatty acid deficiency.
The lipid emulsion does not have to be
mixed with the amino acid and dextrose
solutions in a single bag.
Lipid Emulsion
To prevent hyperlipidemia, lipid emulsions are
not provided continuously. This gives the body
a chance to clear lipids from the blood.
Typically, lipids are administered 2-3 times per
week, but can be provided daily. Infusion times
of 4-6 hours for 10% lipids and 8-12 hours for
20% lipids are recommended, although 12-24
hour infusions may be better tolerated by some
In any event, a total of 2.5g/kg lipids per
day should not be exceeded.
Example calculation of maximum daily
60 kg patient
2.5g/kg x 60 kg
= 150g lipid per day maximum
Practice for 70-100 kg
Evaluation of Lipid
There are three methods that can be
used for evaluation of a patient's lipid
Test dose
Serum triglycerides
Plasma Turbidity
Test Dose Method
10% lipid infused @ 1ml/min for 15-30
min; if no adverse symptoms, the rate
can be increase to 80 - 100 ml/h
20% lipid emulsion infused @ .5 ml/min
for 15 - 30 min; if no adverse symptoms,
the rate can be increase to 40 - 50 ml/h
Serum Triglyceride
Determine a baseline serum triglyceride level
before the emulsion is administered.
Determine the triglyceride level 8 hours after
the infusion has been terminated.
If serum triglycerides are normal or if they
exceed 250 mg/day, lipids should be given at
a reduced rate or should be used only to
prevent essential fatty acid deficiency.
Plasma Turbidity
Plasma is observed for turbidity, and if
turbidity is present, the lipid infusion must
be adjusted. This is not the best method
for testing lipid tolerance, because
hyperlipidemia can occur without
Contraindications for
Lipid Emulsions
Contraindications for using lipid
emulstion include:
Abnormal lipid metabolism
Lipid nephrosis
Acute pancreatitis (if concomitant with or
caused by hyperlipidemia)
Severe egg allergies
Use lipid emulsions with caution if the patient
A blood coagulation disorder
Moderate to severe liver disease
Compromised pulmonary function
For patients who do not tolerate lipid
emulsions, meeting essential fatty acid needs
can be difficult. Rubbing vegetable oil on the
patient's skin may provide some essential fatty
acids, but the efficacy is controversial.
Administration of
Traditionally, lipids are administered in a
bottle that is Y-connected, or
piggybacked to the IV line containing
amino acid/dextrose mixture.
Total nutrient admixtures (TNAs) also
called 3 in 1 systems, allow for lipids to
be administered with amino acids and
Minerals and
Standard mineral and electrolyte
mixtures are available, and are designed
to meet the normal range of daily
mineral/electrolyte requirements.
Individual electrolyte levels can be
altered to meet the needs of patients.
Mineral supplementation can be
calculated based on health status or
laboratory values.
Trace Elements
Standard trace element mixtures are available,
but requirements should be monitored and
adjusted based on serum concentrations.
Iron can be given intramuscularly as needed.
When transferrin levels are low, free iron
increases and can increase susceptibility to
infections. In addition, critically ill or
malnourished patients often have no bone
marrow response to iron.
Copper supplementation must be
administered with caution to avoid
toxicity. Extra zinc may be needed by
some patients to promote wound healing.
Trace Element
Element Dose
Zinc 2.5 - 4.0mg
Copper 0.5 - 1.5 mg
Iron 1.0 mg
Chromium 10 - 15 mcg
Manganese 0.15 - 1.8 mg
Iodine 1 - 2 mcg
Selenium 20 - 40 mcg
Commercial vitamin preparations for TPN are
available. The vitamin requirements for TPN
patients are different from non-TPN patients
because absorption is not a factor with TPN.
When needs are increased for certain disease
states, single vitamin supplements can be
added to the solution. Serum vitamin levels can
be monitored and dosage adjusted
Vitamin preparations should be added to
the TPN solution just prior to
administration to avoid losses from light
Water/Fat Soluble
Water soluble vitamins are provided at
levels greater than the RDA since rapid
administration exceeds renal threshold
and therefore increases urinary losses.
Fat soluble vitamins can become toxic,
and are provided in amounts equal to the
RDA, except for Vitamin K.
Vitamin K is not provided because it may
interfere with anticoagulant medications.
Vitamin K must be given parenterally or
intramuscularly, at a dose of 2-4 mg/wk,
depending on prothrombin time. A long
prothrombin time indicates an increased
vitamin K need.
Other Components of
PN Solutions
Other components commonly added to
parenteral solutions include:
Can be added if serum albumin levels are very low.
An anticoagulant used to prevent blood clots from
forming on the IV catheter.
Used if needed to regulate blood glucose levels.
Ordering and Mixing
PN Solutions
The physician writes the order for the TPN
prescription. Often a form is used.
The pharmacist mixes the TPN solution using
aseptic technique. Prescriptions are
compounded by mixing the solutions at a 1:1
dextrose-to-amino acid ratio and placing in 1-L
bags. Alternatively, lipids can be mixed with the
dextrose/amino acid solution, referred to as the
3-in-1 total nutrient admixture (TNA).
Calculation of protein
Protein requirements vary with the
patient's disease state. Protein needs
can be estimated by multiplying
kilograms of body weight by a factor, or
by making a nitrogen balance study.
Gram/kg Method for
Determining Protein Needs
The simplest, but least precise, method to
estimate protein needs is by multiplying IBW in
kilograms by a factor appropriate for the
patient's condition.
If this method is used, the patient must be
monitored for protein status to determine if
adjustment in the protein prescription is
Example Gram/kg Calculation
IBW: 120lb; 54.5 kg (120/2.2)
Moderate stress (factor = 1.5 from chart)
54.5 kg x 1.5 g/kg = 81.75 (82) grams of
1. Adult non-stressed; IBW= 60 kg
2. Adult moderately stressed; IBW= 70 kg
3. Non- stressed; 2 y/o; IBW= 12 kg
Calculation of Energy
Energy needs of the hospitalized patient can
be determined by several methods.
1. = Basal Energy Expenditure x activity factor x
stress factor.
2. Kcals per kilogram body weight according to
weight and activity classification.
Keep in mind that individual needs vary.
Each of these methods provides a
ballpark value. Patients must be
monitored for weight status and the kcal
prescription should be adjusted
There are two main methods to ascertain
basal energy expenditure (BEE) - either
indirect calorimetry or via a prediction
equation, the most common of which is
the Harris Benedict Equation (HBE).
Once BEE has been determined, that
figure is multiplied by an activity factor
(AF) then an injury factor (IF) to determine
the total energy needs of the patient.
Activity factor =
1.2 if patient is confined to bed
1.3 if patient is ambulatory
The Harris-Benedict
The Harris Beneditc Equation (HBE) is
one of over 200 equations for estimating
basal energy expenditure (BEE). The
HBE is a regression equation taking into
consideration gender, height, weight and
age. The HBE for men and women is as
BEE (kcal/d) = 66.5 + (13.8 x W) + (5.0 x H) - (6.8 x
BEE (kcal/d) = 655.1 + (9.1 x W) + (1.8 x H) - (4.7 x
Where W = weight in kg
and H = height in cm
Example BEE Calculation
Male; W=60 kg; H=150 cm; A=30 years
BEE (kcal/d) = 66.5 + (13.8 x 60) + (5.0 x
150) - 6.8 x 30)
66.5 + 828 + 750 - 204 = 1440
1. Male; 70 kg; 170 cm; 60 y/o
2. Female; 50 kg; 160 cm; 40 y/o
3. Male; 80 kg; 180 cm; 35 y/o
Example Energy Needs
Estimate energy needs (kcals) using
BEE x AF x IF BEE = 1000 kcals
Energy needs = 1000 x 1.2 x 1.2 = 1440
Initial Considerations
TPN infusion should start slowly so that the
body has time to adapt to both the glucose
load and the hyperosmolarity of the solution,
and to avoid fluid overload.
A pump controls the infusion rate of the TPN
There are specific steps in the inititiation
procedure to follow regarding the initiation of
TPN infusion.
General PN Initiation
Start with 1 liter of TPN solution during the first
24 hours (or use 42 cc/hr as a typical start rate)
Increase volume by 1 liter each day until the
desired volume is reached
Monitor blood glucose and electrolytes closely
Pump administer TPN at a steady rate
Don't attempt to catch up if administration
gets behind.
Continuous vs. Cyclic
With cyclic TPN, the patient is fed at
so he or she can be free from the TPN
pump during the day
Typically, the TPN solution is infused at a
constant rate controlled by a pump.
However, if the patient is to be nourished
via TPN for an extended period of time,
cyclic TPN is often used.
With cyclic TPN the patient is fed for 12-
18 hours during the night and fasts
during the day. This gives the long-term
TPN patient freedom from the machinery
to lead a less restricted life during the
Cyclic TPN helps prevent hepatotoxicity
that can develop with long-term TPN and
the fasting period allows essential fatty
acids to be released from fat stores.
The initial TPN prescription is based only
on estimates of the patient's kcalorie,
protein, and micronutrient needs. The
patient's weight, protein, and
micronutrient status must be monitored
to ensure the prescription's adequacy.
Assessment considerations include:
Maximum weight gain in anabolism is 1/4
to 1/2 pound per day. More than that
indicates fluid retention.
Adjust calcium lab values in
hypoalbuminemic patients as follows:
ionized CA = (measured serum CA) +
[4.0 - actual albumin (g/dL)] x 0.8
Terminating the
The procedure for terminating the TPN
infusion is controversial. Some patients
can tolerate an abrupt stop, and others
tolerate a gradual termination, over a two
hour period, better.
Rebound Hypoglycemia
Gradual termination prevents rebound
hypoglycemia, especially for diabetic, septic,
and stressed patients.
The endocrine system adjusts to a continuous
infusion of dextrose by secreting a certain level
of insulin. If the dextrose supply is withdrawn
suddenly, the insulin level will not adjust right
away, resulting in a relative insulin excess and
Transitioning to Tube
To ensure that the patient's nutrient needs
continue to be met, the TPN infusion should be
continued when the tube feeding begins..
If the gut hasn't been used for two or more
weeks, enteral feeding tolerance may be
TPN infusion can be decreased in proportion
to the increase in tube feeding.
Hints to Increae
Enteral Formula
To enhance enteral formula tolerance
Start at slow rate (30 mL/hour) and/or with
half-strength formula
Avoid hyperosmolar forumlas
Do not use bolus feedings
Diluted hydrolyzed protein may stimulate
gut hypertrophy if formula isn't tolerated
Transitioning to Oral
To ensure that the patient's nutrient
needs are met, TPN infusion should
continue while oral feedings are initiated.
Because the digestive tract can atrophy
if not used for more than two weeks, food
may not be tolerated well at first. TPN
should be continued until nutrient needs
are met with food.
Hints to Increase
Tolerance of Oral
To enhance enteral formula tolerance:
If the patient is consuming an enteral formula
serve it diluted
Have patient sip small volumes frequently at first
Gradually increae volumes and time between
If patient is to be weaned for food, use transitional
diets (easily digested), starting with clear liquid.
Nutritional Recovery
The nutritional recovery syndrome, (px is
fedd aggressively) sometimes called the
refeeding syndrome, results from overly
aggressively feeding patients who are
severely malnourished or who haven't
eaten in a long period of time.
Refeeding a starved person results in a
shift of potassium and phosphorus into
the body's cells for ATP production,
which can result in electrolyte imbalance.
Therefore, refeeding a severely
malnourished patient should occur
gradually, and the patient should be
monitored closely.
Calculation of Protein
To calculate the grams of protein supplied by a
TPN solution, multiply the total volume of
amino acid solution (in ml*) supplied in a day
by the amino acid concentration.
If the total volume of AA is not stated in the
prescription, you can calculate it. Just multiply the
rate of infusion of AA by 24 hr.
*Remember that 1 ml = 1 cc.
Example Protein Calculation
1000 ml of 8% amino acids 1000 ml x 8
g/100 ml = 80g
Calculation of
Dextrose Content
To determine kcalories supplied from dextrose
in the TPN solution, you must first calculate
grams of dextrose. Multiply the total volume of
dextrose soln (in ml) supplied in a day by the
dextrose concentration. This gives you grams
of dextrose supplied in a day. Multiply the
grams of dextrose by 3.4 (there are 3.4 kcal/g
dextrose) to determine kcalories supplied by
dextrose in a day.
If the total dextrose volume is not stated in
the prescription, you can calculate it. Just
multiply the rate of infusion of dextrose by 24
*Remember that 1 ml = 1 cc.
Example Dextrose Calculation
1000 ml of D50W 1000 ml x 50g / 100 ml
= 500g dex
500g dex x 3.4 kcal/g = 1700 kcal
1. 1.5 L D50W= g? kcal?
Calculation of Lipid
Since lipid emulsions contain glycerol,
the lipid emulsion does not have 9 kcal
per gram* as it would if it were pure fat.
To determine kcalories supplied by lipid,
multiply the volume of 10% lipid (in ml)
by 1.1; multiply the volume of 20% lipid
(in ml) by 2.0.
If lipids are not given daily, divide total
kcalories supplied by fat in one week by
7 to get an estimate of the average fat
kcalories per day.
*Note: Some use 10 kcal/gm for lipid
Example Lipid Calculation
500 ml of 10% lipid 500 ml x 1.1 kcal/ml =
550 kcal
500 ml 20% lipid 500 ml x 2.0 kcal/ml = 1000
1. 1.5 L 10% lipid
2. 0.75 L 10% lipid
3. 0.5 L 20% lipid
4. 1.25 L 20% lipid
Calculation of
Nonprotein Calories
To determine the nonprotein kcalories
(NPC) supplied per day in a TPN
prescription, add the kcalories supplied
per day from dextrose with the kcalories
supplied per day from lipid emulsion.
Example NPC Calculation
1000 ml/d D50W = 1700 kcal/d 500 ml/d 10%
lipid = 550 kcal/d
1700 + 550 = 2200 nonprotein kcals per day
1. 1.5 L D50W; 500 mL 10% lipid
2. 0.75 L D70W; 250 mL 10% lipid
3. 1.0 L D40W; 500 mL 20% lipid
4. 1.25 L D30W; 250 mL 20% lipid
Calculation of NPC:N
The nonprotein kcalorie to nitrogen ratio
(NPC:N) is calculated as follows:
1. Calculate grams of nitrogen supplied per
day (1 g N = 6.25g protein)
2. Divide total nonprotein kcalories by grams
of nitrogen
Desireable NPC:N Ratios
80:1 the most severely stressed patients
100:1 severely stressed patients
150:1 unstressed patient
Example NPC:N Calculation
80 grams protein
2250 nonprotein kcalories per day 80g
protein/ 6.25 = 12.8
2250/12.8 = 176
1. 2000 kcal; 90 g protein
2. 2250 kcal; 75 g protein
3. 1800 kcal; 105 g protein
4. 3300 kcal; 120 g protein
Calculation of %NPC
from Fat
As fewer than 60% of a patient's
nonprotein kcals should be from fat in
order to prevent hyperlipidemia, it is
important to calculate the percent of non
protein kcals from fat.
To determine the percent of nonprotein
kcals from fat, divide the kcals/d from fat
by the total nonprotein kcal/d and
multiply by 100
Example %NPC Fat Calculation
2250 nonprotein kcal
550 lipid kcal 550/2250 x 100 = 24% fat
1. 2000 total kcal; 550 lipid kcal= %
2. 2250 total kcal; 500 lipid kcal
3. 1800 total kcal; 250 lipid kcal
4. 3300 total kcal; 1100 lipid kcal
Calculation of Solution
The maximum osmolarity tolerated by
PPN is 900-1100 mOsm/L. Therefore, it
is important to calculate the osmolarity of
the PPN solution. Remember that lipids
do not contribute to the osmolarity of the
To calculate solution osmolarity:
1. multiply grams of dextrose per liter by 5
2. multiply grams of protein per liter by 10
3. add a & b
4. add 300 to 400 to the answer from "c".
(Vitamins and minerals contribute about
300 to 400 mOsm/L.)
Example Osmolarity Calculation
1 L D50W (500 g dex/L)
1 L 8% AA (80 g AA/L) 500 g x 5 = 2500
80 g x 10 = 800 mOsm
2500 + 800 = 3300 mOsm/L3300 + 300 to
400 = 3600 to 3700mOsm/L
The prescription is not suitable for PPN
*Assume vitamin/minerals contribute 350
Determination of
EFA Adequacy
To determine if essential fatty acid (EFA)
needs are met by the TPN prescription,
you must know the percentage of EFA in
the lipid emulsion. This information is
supplied by the manufacturer. Most lipid
emulsions are at least 50% EFA.
Multiply the total kcalories of lipid the
patient receives in a day by the percent
of EFA in the emulsion. Compare this to
the patients EFA requirement (2-4% of
Example EFA Calculation
2250 kcals/d
550 kcal 10% lipid (50% EFA) 550 kcal x 50% = 275
kcal EFA
275/2250 x 100 = 12% EFA
EFA needs are being met
1. 2000 total kcal; 500 mL 10% lipid
2. 2250 total kcal; 500 mL 20% lipid
Determination of Fluid
luid needs for an individual can be
calculated as 1 ml/kcal or 35 ml/kg usual
body weight (UBW).
Patients who have large water losses
through perspiration or oozing wounds
may require more fluids.
Calculation of Fluid
In general, adults need 35 mL water per kg
body weight, children need 70 -100 mL/kg, and
infants need 150 mL/kg.
Fluid needs are increased with excessive
sweating, vomiting, diarrhea, or tube drainage.
Fluids are restricted in certain disease states
such as renal failure and congestive heart
Example Fluid Needs Calculation
70 kg man:
35 mL/kg x 70 kg = 2450 mL/d
30 kg child:
70 to 100 mL/kg x 30 kg = 2100 to 3000
5 kg infant:
150 mL/kg x 5 kg = 750 mL/d
Obligatory Fluid Output
One way to assess the appropriateness
of fluid intake is to monitor the patient's
urine output.
Obligatory fluid output is the minimum
output of urine necessary to remove
wastes and is estimated to be roughly
700 mL per day or 30 mL per hour.
Monitoring Hydration
Hydration status can be monitored via
daily weights, hematocrit, blood urea
nitrogen (BUN), and electrolyte levels.
High values for the above parametres
indicate dehydration. Also, a weight
change of 2.2 pounds repesents 1 L of
fluid if the weight change is due entirely
to fluid loss or gain.
Nutritional assessment indicators of
protein status can be used to determine
adequacy of protein intake, and weight
can be used to determine adequacy of
kcalories, unless the patient is retaining
Calculation of
PN Prescription
There are different ways to calculate
parenteral nutrition prescriptions to meet
the patient's nutritional needs.
Standard or "ready-mixed" bags of
dextrose and amino acid solutions exist
and are used for some patients.
TPN prescriptions can be calculated and
compounded to meet the patient's
specific nutritional needs precisely. Two
methods for calculating TPN solutions
Dex/AA with Piggyback
Determine patient's kcalorie, protein, and fluid
Determine lipid volume and rate for "piggy
back" administration.
Determine kcals to be supplied from lipid. (Usually
30% of total kcals).
Divide lipid kcals by 1.1 kcal/cc if you are using 10%
lipids; divide lipid kcals by 2 kcal/cc if you are using
20% lipids. This is the total volume.
Divide total volume of lipid by 24 hr to determine rate
in cc/hr.
Determine protein concentration.
Subtract volume of lipid from fluid requirement
to determine remaining fluid needs.
Divide protein requirement (in grams) by
remaining fluid requirement and multiply by
100. This gives you the amino acid
concentration in %.
Determine dextrose concentration.
Subtract kcals of lipid from total kcals to
determine remaining kcal needs.
Divide "remaining kcals" by 3.4 kcal/g to
determine grams of dextrose.
Divide dextrose grams by remaining fluid needs
(see 3a) and multiply by 100 to determine
dextrose concentration.
Determine rate of AA/dex solution by
dividing "remaining fluid needs by 24 hr.
Example Calculation
Nutrient Needs:
Kcals: 1800 Protein: 88 g Fluid: 2000 cc
Lipid (10%): 1800 kcal x 30% = 540 kcal
540 kcal
1.1 kcal/cc = 491 cc/24hr =
20 cc/hr 10% lipid
Remaining fluid needs: 2000cc - 491cc = 1509cc
Remaining kcal needs: 1800 - 540 = 1260 kcal
Protein: 88 g / 1509 cc x 100 = 5.8% amino acid solution
Dextrose: 1260 kcal/
3.4 kcal/g = 371 g dex
371 g / 1509 cc x 100 = 24.6%
dextrose solution
Rate of Amino Acid / Dextrose: 1509 cc /
24hr = 63 cc/hr
1. Nutrient Needs:
Kcal: 3000
Protein: 120 g
Fluid 2800 cc
20% lipid emulsion at 30% of kcals
Lipid kcals provided= ?
Volume of solution=?
Rate of administration= ?
Unmet Needs:
Remaining kcals:
Remaining Fluid:
Protein Concentration:
Grams of Dextrose:
Dextrose Concentration:
Rate of AA/Dex solution administration:
3 in 1 TNA Solutions
Determine patient's kcalorie, protein, and fluid
Divide daily fluid need by 24 to determine
rate of administration.
Determine lipid concentration.
Determine kcals to be supplied from lipid. (Usually
30% of total kcals).
Determine grams of lipid by dividing kcal lipid by 9.
Divide lipid grams by total daily volume (= fluid
needs or final rate x 24) and multiply by 100 to
determine %lipid.
Determine protein concentration by dividing
protein needs (grams) by total daily volume
and multiply by 100.
Determine dextrose grams.
Subtract kcals of lipid from total kcals to
determine remaining kcal needs.
Divide "remaining kcals" by 3.4 kcal/g to
determine grams of dextrose.
Determine dextrose concentration by
dividing dextrose grams by total daily
volume and multiply by 100.
Example Calculation
Nutrient Needs:
Kcals: 1800 Protein: 88 g Fluid: 2000 cc
Lipid (10%): 1800 kcal x 30% = 540 kcal
540 kcal / 9 kcal per gram = 60 g
60 g / 2000 cc x 100 = 3% lipid
Protein: 88 g / 2000 cc x 100 = 4.4% amino
acid solution
Dextrose: 1260 kcal
3.4 kcal/g = 371 g dex
371 g / 2000 cc x 100 = 18.6% dextrose solution
Rate of Amino Acid / Dextrose: 2000 cc / 24hr
= 83 cc/hr
Calculation of
Additional Water
When using standard or "ready-made" TPN
solutions, you need to ensure that fluid needs are
being met. To determine the additional sterile water
prescription for the TPN solution, you need to know
the patient's fluid needs.
Subtract volume of TPN solution provided in a day
from the fluid requirement. The difference is the
volume of sterile water that should be added to the
TPN solution.
Example Water Rx Calculation
Fluid needs = 2450 ml/d TPN Rx
provides 2000 ml fluid per day
2450 ml - 2000 ml = 450 ml additional
sterile water needed
Calculation of Fluid
In general, adults need 35 mL water per kg
body weight, children need 70 -100 mL/kg, and
infants need 150 mL/kg.
Fluid needs are increased with excessive
sweating, vomiting, diarrhea, or tube drainage.
Fluids are restricted in certain disease states
such as renal failure and congestive heart
Example Fluid Needs Calculation
70 kg man:
35 mL/kg x 70 kg = 2450 mL/d
30 kg child:
70 to 100 mL/kg x 30 kg = 2100 to 3000 mL/d
5 kg infant:
150 mL/kg x 5 kg = 750 mL/d


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This is my second hair straightener. My first was a Babyliss and I did not manage to do some nice curls, the Babyliss did not glide through the hair. This GHD feels professional. The heating goes very fast. It is quiet hard to learn how to do the perfect curls with this straightener but I hope to learn the technique some day! I noticed that it is easier to do curls on other peoples hair than your own. I have to practice. And I hope this styler will last forever!
Everyone from the pros to at-home haircare lovers will adore this new model from ghd, as its range of benefits and features promise an experience like no other. Easy, light and stress-free, you'll love straightening your hair on the regular with this soon-to-be coveted product. Stylist Bryce Scarlett created this gorgeous look on Aussie babe Margot Robbie using the new ghd Gold.
Top stylists, models and celebrities alike can't live without their ghds, so you know you're in good company when you add to your collection. Whether using your ghd styler to tame frizz for a day at your desk, or to curl locks for a night out on the town, ghd not only allows you to straighten your hair, but also twist, curl, flick, wave and bounce too. With ghd, the possibilities are endless.
This ghd Gold Classic Styler shines bright with a luxe, sleek design that gives a professional finish. The luxurious plates smooth your hair for an ultra-shiny result, with contoured edges that help to create perfect curls and waves. The innovative golden plates have a high-gloss finish to glide through hair effortlessly, giving you a salon perfect finish every time. The ghd Gold Classic Styler stay cooler to touch for longer and are lighter to handle, and the universal voltage ensures same styling performance wherever you are in the world.
Giving you ultimate control of your hair, ghd's range of brushes innovatively style hair without causing static, helping to create the optimum silky smooth blow-dry. The ghd Ceramic Brush features a ceramic barrel to retain heat too, making sure your blow-dry is super speedy and the natural bristles on the Natural Bristle Radial Brush work to create a smoother finish, adding volume to mid-length hair.
To have straight hair, you just mist your hair with the GHD thermal protector. You then start at the part of the hair that's closest to the roots, and then you glide the GHD Classic 1-inch Styler to the tips in one smooth stroke. You can also follow the easy directions for soft movement and for curls, which involve some turning while you glide from root to end.
* * * Update: After returning the above-described item, I bought a ghd Classic Styler in-person from one of their authorized salon dealers (info at ghd's site). When I went to register the hologram and date codes, the ghd site accepted them on the first try. Also, the second unit I bought HAD country-of-manufacture information on the box and on the date sticker (made in China, which some other comments said isn't legit, that seems to be wrong). My unit labeled made-in-China is the one that registered successfully with ghd. Also my second purchase - from the authorized dealer - had a lot of information printed on the bottom of the box, including a bar code, web info, consumer information phone number, design info and information about the product. The unit I purchased from Amazon had NO printing on the bottom of the otherwise authentic-looking box. Draw your own conclusions. Bottom-line: if you buy a ghd styler here, double and triple-check that your unit is for real.
Looked around at new ones, checked reviews and other ghd models and decided (based on price mainly) that I would just buy the same 'original' one again. It's great. Better results- smooth and straight with little effort - and quicker heat up than my old one - extremely quick. Much cheaper than the fancier models. Slim and easy to store away. Glad I went for this again.
Top stylists, models and celebrities alike can't live without their ghds, so you know you're in good company when you add to your collection. Whether using your ghd styler to tame frizz for a day at your desk, or to curl locks for a night out on the town, ghd not only allows you to straighten your hair, but also twist, curl, flick, wave and bounce too. With ghd, the possibilities are endless.


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Trench Cake Recipe
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Top Spouse Abuse Quotes
Browse top 2 famous quotes and sayings about Spouse Abuse by most favorite authors.
Favorite Spouse Abuse Quotes
1. "The greatest spiritual leaders in history have all preached love for others as the basis for all happiness, and never did they accompany such mandates with a list of unlovable actions or deeds. They never said, love everybody except for the gays. Love everybody except for the homeless. Love everybody except for the drug users. Love everybody except for the gang members, or those covered in ink, or the spouse abusers. They didn't tell us it was okay to love everybody with the exception of the "trailer trash," those living in poverty, or the illegal immigrants. They didn't tell us it was okay to love everybody except for our ex-lovers, our lovers' ex lovers, or our ex-lovers' lovers. The mandate was pretty damn clear, wasn't it?Love others.Period."
Author: Dan Pearce
Author: Dan Pearce
2. "Ignore that nightmare in the bathroom. Just another ugly refugee from the Love Generation, some doom-struck gimp who couldn't handle the pressure. My attorney has never been able to accept the notion - often espoused by reformed drug abusers and especially popular among those on probation - that you can get a lot higher without drugs than with them. And neither have I, for that matter."
Author: Hunter S. Thompson
Author: Hunter S. Thompson
Spouse Abuse Quotes Pictures
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Today's Quote
If Christ were born in Bethlehem a thousand times and not in thee thyself; then art thou lost eternally."
Author: Angelus Silesius
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Senior Product Manager
Ninja Theory, a BAFTA award winning games studio in Cambridge, UK is looking for a dynamic and experienced Senior Product Manager to join the wider commercial team and report to the Commercial Director.
The successful candidate will be highly organised and driven by delivering the very best products to our fans. They will be an established games industry professional with at least 5 years' experience in product management/brand management/marketing roles.
It is essential that we have somebody who is a doer, a thinker and a confident communicator that can drive delivery and success. They must have a go-getter attitude and not be afraid to wear multiple hats to achieve the studio and development teams' goals.
Does this sound like you? If so we can offer you a fun, hard-working and supportive environment in which you can quickly make a contribution. Alongside this there's the opportunity for career development, training and promotion plus a competitive salary and a whole heap of benefits!
To apply, please send us your CV and application form [docx|pdf] along with a covering letter telling us why you would make a fantastic Senior Product Manager to email@example.com. Please quote reference NT/SPM/FEB19 in the subject bar. We aim to get back to you with feedback as soon as possible after we have received your application.
Unfortunately, we are unable to accept candidates who require a VISA for this position.


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Adding Extra Flavor To Your Party
Posted on 9 November, 2017 in Entertainment
There is no definite reason for the party givers to organize party for the friends and colleagues. Any reason could be enough for the party givers to organize the party. Now, you can add new charm to your party by hiring the services of photo booth which is available at various places near London like Hampshire. Rental companies provide these photo booths for specific time for a specific amount. You can go for photo booths hire in Hampshire.
Services provided by the booth rental companies
- Open air booth: It is the latest type of photo booth where there is no booth. The camera is set on the tripod and you are supposed to have your own customized background.You can use the various props kept there to make the photo session funky and live. As you press the start button, camera is all set to take photographs one by one.
- Old school photo booth: In this type of photo booth the guest enters the shooting room and makes different types of funny faces. When you see the results of this photo session you feel that the child inside you is still alive. So, in some occasions you should allow the little child to come out of your skin and enjoy.
- Slow motion video booth: This booth allows the guests to make various actions and faces in slow motion, thus allowing them to make short video clips of their funny actions and let them have the liberty to do whatever they want during their video shooting session.
Photo Booth To Make Every Occasion Special
Posted on 15 October, 2017 in Entertainment
This article was provided by OH Snap Selfie Photo Booth
The essence of every party, festival and special occasion is to have a memory of it. Photographs give you a memory that you can cherish in later phase of life. To capture your moment perfectly, make sure to hire professional photographer. A photo booth is a great idea to add hue of fun and drama to your party. Photo booth in Houston ensures that every occasion and party remains enjoyable and entertaining. One of the most prominent reasons of having photo booth is that it is budget friendly; even if you have a tight budget, you can make sure to click every photograph of the guests. Cheap photo booth rental in Houston can make every guest feel special and you can give them memento that they will cherish for lifetime.
Things to consider before hiring a photo booth
Props are the essence of the any photo booth. Make sure the photo booth which you hire has creative props in huge numbers. The more the props the more will be the enjoyment quotient in the party. In order to make your party spectacular, you can also hire a fun attendant. Fun attendant engages the guests in the party and makes sure that guests do not get bored. Make sure that the photo booth company reaches the destination of your event prior to every guest to set up the photo booth. They should be prepared well in advance with back up cameras and machines. Before hiring any company, make sure to read the reviews about the company.
Add Some Drama In Your Life By Playing Escape Room Games
Posted on 5 October, 2017 in Entertainment
Several games are there which you can play, but if you want to play something real and adventurous then escape room can be your choice which is getting very popular in Irvine. It is a type of physical game in which you need to solve the puzzles with help of the clues. Along with clues, you need to make some effective strategies and planning in order to complete the puzzle and to win the game. This is a time based game in which you need to work on puzzle within the given time period. There are different types of escape rooms which you can play. Some of them include space station, dungeons and police cells. In fact, this game has become so famous that it is now played by adults all round the world.
Who can play this game?
This game is meant for all age groups starting from young to teenage and from middle aged to old people. In fact, there are many offices in Irvine where colleagues play escape rooms as it is really fun and enjoyable as well. Along with colleagues, friends and coworkers you can also play this game with your family members as well. This will help in making your bond much better with your family and through this, you will get a chance to spend some quality with family. It is one of the best options to build team and team-spirit which will help in achieving better results.
Interested in this game? go here.
Best Unique And Creative Ideas To Make Your Kid's Birthday Party A Great Fun!
Posted on 17 August, 2017 in Entertainment
Planning for your kid's birthday party anytime soon? Well, a kid's party involves so much of work isn't it?
Well, not to worry anymore! Being a resident of San Antonio, planning for a party can be very easy. All you need is to hire professional San Antonio party planner and let them plan your event according to your needs! Read on to know some of the most amazing ideas that will help you get the best out of your child's party.
Go for an interesting and fun theme!
While it is common to go for themed napkins and plates, choosing a theme that can best reflect your kid's special interests will personalize the party and will make it much easier to pull everything together. For instance, if your kid loves animals, you can go for a safari or zoo theme.
Give your kids some freedom!
Plan for the activities but at the same time give your kids space and let them express themselves. You can even set up the art stations around party area where the kids can choose the projects that they want to create.
Ditch the table!
This time, think some unique rather than setting up chairs and couches seating around a table. While it may be best for grown-ups, kids love new ideas. You can even create pillow lounge since kids are more flexible!
Hire the best party planner right away to make your child's party memorable and a lot of fun. Let them organize it at their best!
Join The Hunting Tour To Experience The Adventure
Posted on 13 August, 2017 in Hobby/Sport
Pheasant hunting is a great experience for the first time hunters. If you have never hunted before join pheasant hunting tours with the outfitters. Different types of hunting tours are organized in different parts of the world to allow hunting in a controlled manner. Pheasant hunting outfitters provide group hunting tours according to your schedule so that you can enjoy a great hunting experience. They take you to the place which is ideally created for the purpose of hunting. Perfect habitat is provided to the pheasants so that hunters can easily get the enough pheasants for hunting.
Get the services of guide on the hunting tours
Pheasant hunting tours are generally organized under the guidance of trained hunting professionals. Guide services are beneficial for the first time hunters. No one wants to miss the chance of hitting the bird on hunting tours. Hunting guide helps the hunters to learn shooting with guns. It improves their shooting and targets setting skills which makes it easy for them to shoot the bird. Hunting guide makes sure that you hunt the pheasants in the defined area only so that you can enjoy the safe hunting experience. It's a happy feeling for you when you shoot the bird by your own.
Luxury accommodation on the hunting tours
Various companies are there which organize the hunting trips. In addition to the hunting opportunity, they provide luxury accommodation for the hunters so that they enjoy full comfort during the hunting tour. Along with the accommodation, food and dining facilities are also arranged for the hunters. This makes their trip comfortable and full of excitement.
Convert Boring Corporate Photography Into Fun Photography
Posted on 5 August, 2017 in Entertainment
Photo booths are the best alternative for traditional photography which is less attractive. You must have heard about the photo booth hire for informal parties and events but these days there is a growing popularity of the photo booth hire for corporate parties and events. Modern corporations are not behind in making the event photography attractive. Hence, most of the organizations tend to hire the services of corporate photo booth hire companies to provide best photo booths for the corporate events. These types of photo booths are nothing different from the other types of events, but they add a fun factor to your boring corporate photography.
Create the best moments with your colleagues
At the photo booths, you will see some different colors of your colleagues and seniors that you have never seen before. From getting clicked in the background with flowers to the clouds, a different touch will be added to your photographs. Apart from getting clicked in the traditional poses with your colleagues, you can share some funny moments of clicking pictures with your office mates. Installing the photo booth creates the perfect fun stuff at the boring corporate events,
Hire fully equipped photo booths
These days, photo booths are not merely the set up which provides just a background for clicking pictures. Advanced photo booths are the well equipped set ups which include attractive lightings, video making also. In addition to these, you can get the quick prints of your photographs and even share their photos instantly.
All New Types Of Retro Game Consoles That You Can Prefer
Posted on 30 July, 2017 in Entertainment
Games can be the best way to spend some quality time with your friends, family and children. They are very fun, adventurous and exciting and help in reducing stress and tension. There are different types of games that you can play but if you want to relive your childhood memories again then retro games are the best option. Till now, they are famous as they were famous sometime before but yes with change in time many changes have come in their playing options, techniques and most importantly in their consoles which is the main element of this game. If you will not have console you will not be able to play this game.
What are consoles and their importance?
A video game console is a device that requires attachment with television or monitor in order to start and play the game. They consist of storage devices such as hard disk, memory cards, optical disks etc. in order to store all the important content of the game. There are different types of advanced retro game consoles available in the market these days offering a number of features and benefits. Their price may vary depending on their technology, features and playing option. Due to this, it becomes necessary that while buying any console you should do some research and set your budget well in advance. These days, Wi-Fi consoles are in great demand because they are very efficient and are provided with a number of features. These types of consoles have taken retro gaming to the next level that has changed the way of playing and with increase in demand many gaming brands are coming up with their own consoles.
Useful Tips to Keep The Kids busy And Entertained This Weekend
Posted on 20 July, 2017 in Entertainment
The weekend is approaching and you wish to entertain your kids. Most of the parents try a bounce house. However, it could be a bit difficult to move them especially in a small vehicle. It requires time to inflate them and make them ready. Also, even a tiny hole in the bounce hole could ruin the plan.
Benefits of the foam parties
You could try the new and much better foam machine. The foam parties for the kids are gaining huge popularity. They are not only fun and novel, but an exciting experience for your children. You would not face any difficulty transporting the powder packs and the super lightweight foamer. It will take not more than five minutes to set the things. The good quality foam would easily last for 10 hours or even more.
They are 100% safe
Machines used in these parties are foolproof. If you are worried about the after effects of the foam machine on your skin, relax. The foam is prepared from 100% chemical free products and will never harm your skin and eyes. Once the party is over, pack up will hardly take 3- 5 minutes. You will not have to cleanup because the foam will get converted into water.
Explore the internet for some amazing packages. Some of the reputed companies sell combo of two machines at highly affordable prices. They provide powder packs along with the additional packs at a discount. Such machines are suitable for haunted houses, birthday parties, summer camps etc.
Head To Las Vegas For The Costume Of Your Choice
Posted on 14 July, 2017 in Entertainment
There are incredible stores in Las Vegas for costumes. It is a place beaming with life and everyone is high on energy. An innumerable variety of costumes are available here and they also provide custom made dresses. There are also a number of Las Vegas costume stores which provide these services online. The diverse costumes which are currently very popular are-
Superheroes- Batman, spiderman, ironman and all the heroes have continued to mesmerize kids with their powers and so the demand for these is always on a rise.
Disney costumes- Mickey Mouse, Belle, Elsa, Donald Duck, Princess Jasmine, Anna, Rapunzel have been a favourite with children as well as adults. People love to dress up like these characters.
Star war characters- this is another category which is sought after today.
Scary costumes- people love to be a little goofy and dress up like demon Freddy or a popular witch. Monster costumes are easily available too. To enhance these costumes scary masks, creepy props, Jason masks and dresses etched with blood are always on the rise.
Wigs- an enormous range of wigs is available. There are the ones with coloured stylish hair, the scary ones with a ghost-like appearance and the afro wigs. The clown wig and Michael Jackson wig is really popular. Princess Leia wig is demanded by girls in a huge number.
The huge variety really boggles our mind. Every day something new is produced. The costumes of celebrities are also sought after.
This article was provided by americancostumes.com
Hire The Bounce Houses And Let The Kids Enjoy
Posted on 4 July, 2017 in Entertainment
Bouncing castles are the best things that attract the attention of the kids. Most of the people today hire the bounce houses so that the kids can have a lot of fun. Your child's playtime can become more interesting and enjoyable when you introduce bounce houses to your child.
These bouncing houses are mostly taken on rent but if you wish you can also get one for your house. There are many bounce house rental services available that can provide you the best houses as per the theme and requirement. They come at the place of the event and properly install the house keeping the safety of kids in mind. The children who come at the event can enjoy in these bouncing houses.
How it works?
These bounce houses can also be known as water slides, moonwalk, obstacle courses etc. Working of these bouncing houses depends on the air flow. Continuous air flow inside the house or structure inflates the house and makes it bouncy. In order to fill the surface with the air, blower is connected with the inner part of the surface which maintains the continuous flow of air and makes the surface inflated.
There are basically two different types of bouncing houses available, first one is the commercial type and the second one is the residential one. Commercial houses are made up with heavy quality and durable material as compared to residential one which is made up of light weight material in which not more than 3-4 kids allowed at a time.


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