Weight reduction

  Minim reg: 2400 calories 

For weight reduction: 1000 calories (daily intake)


         

 How many calories  need to lose weight?

         
Men:   BMR = 66 + (13.7 X wt in kg) + (5 X ht in cm) - (6.8 X age in years)
  Women: BMR = 65 + (9.6 X wt in kg) + (1.8 X ht in cm) - (4.7 X age in years)

For Example:

Male, 83 kilos, 181cm

BMR = 66 + (13.7 x 83) + (5 x 181) – (6.8 x 28)
BMR = 66 + 1137.1 + 905 – 190.4
BMR = 1917.7 calories

Total Daily Energy Expenditure

Total Daily Energy Expenditure is the total number that your body burns each day through activity. When you know how many you burn each day through physical activity, then you know the following:

• How many calories you need each day to maintain your weight
• How many calories you need each day to lose weight

It is often calculated using the Harris Benedict Equation which multiplies your daily BMR by an activity factor which you choose accordingly (See below).

Activity Factor

Your activity factor is a number determined from a scale based on how active you are on a daily basis.

• Sedentary (little or no exercise, desk job) multiply BMR by 1.2
• Lightly active (light exercise/sports 1-3 days per week) multiply your BMR by 1.375
• Moderately active (moderate exercise/sports 3-5 days per week) multiply your BMR by 1.55
• Heavily active (hard exercise/sports 6-7 days per week) multiply your BMR by 1.725

Total Daily Energy Expenditure = BMR x Activity Factor

My example = 1917 x 1.4 = 2683.8 calories

How does this help me lose weight?

Now that I know my Total Daily Energy Expenditure I know that a daily intake of this amount will help maintain my current weight.

In order to lose weight I know that I need to intake less calories then I burn. This is called a calorie deficit.

So given that my Total Daily Energy Expenditure is 2683.8calories, I might set my goal at a daily intake of 2183 calories, creating a 500 calorie energy deficit. If I burn energy daily at this rate, I can expect to lose roughly 1 pound in a week.

Calories in Fruits per 100 Grams

Calories in Apple 56

Calories in Avocado Pear 190

Calories in Banana 95

Calories in Chickoo 94

Calories in Cherries 70

Calories in Dates 281

Calories in Grapes Black 45

Calories in Guava 66

Calories in Kiwi Fruit 45

Calories in Lychies 61

Calories in Mangoes 70

Calories in Orange 53

Calories in Orange juice 100ml 47

Calories in Papaya 32

Calories in Peach 50

Calories in Pears 51

Calories in Pineapple 46

Calories in Plums 56

Calories in Strawberries 77

Calories in Watermelon 26

Calories in Pomegranate 77

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Calories in Vegetables per 100 Grams

Calories in Broccoli 25

Calories in Brinjal 24

Calories in Cabbage 45

Calories in Carrot 48

Calories in Cauliflower 30

Calories in Fenugreek (Methi) 49

Calories in French beans 26

Calories in Lettuce 21

Calories in Mushroom 18

Calories in Onion 50

Calories in Peas 93

Calories in Potato 97

Calories in Spinach 100g

Calories in Spinach 1 leaf

Calories in Tomato 21

Calories in Tomato juice 100ml 22

Calories in Cereals per 100 Grams

Calories in Bajra 360

Calories in Maize flour 355

Calories in Rice 325

Calories in Wheat flour 341

Calories in Breads per piece

1 medium chapatti 119

1 slice white bread 60

1 paratha (no filling) 280

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Calories in Milk & Milk Products per cup

Calories in Butter 100gms. 750

Calories in Buttermilk 19

Calories in Cheese 315

Calories in Cream 100gms. 210

Calories in Ghee 100gms 910

Calories in Milk Buffalo 115

Calories in Milk Cow 100

Calories in Milk Skimmed 45

Calories in Other Items

Calories in Sugar 1 tbsp 48

Calories in Honey 1 tbsp 90

Calories in Coconut water 100 ml 25

Calories in Coffee 40

Calories in Tea 30

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        Management of Moderate to Severe Burns


                       Initial Fluid Resuscitation - The Parkland Formula




Initiation of fluid resuscitation should precede initial wound care. In adults, IV fluid resuscitation is usually necessary in second- or third-degree burns involving greater than 20% TBSA. In pediatric patients, fluid resuscitation should be initiated in all infants with burns of 10% or greater TBSA and in older children with burns greater than 15% or greater TBSA.
Two large-bore IV lines should be placed. Lactated Ringer's solution is the most commonly used fluid for burn resuscitation.
The Parkland formula is used to guide initial fluid resuscitation during the first 24 hours.

The formula calls for 4 cc/kg/TBSA burn (second and third degree)

 of lactated Ringer's solution over the fast 24 hours.

Half of the fluid should be administered over the first eight hours post burn, and
the remaining half should be administered over the next 16 hours.
Formula:

Adults / Adolescent : mL LR = 2 * Weight(kg) * %Burn
Children : mL LR = 3 * Weight (kg) * %Burn


 The volume of fluid given is based on the time elapsed since the burn.
Urine output should be used as a measure of renal perfusion and to assess fluid balance. In adults, a urine output of 0.5-1.0 mL/kg/h should be maintained. Patients with significant burns should have a Foley catheter inserted in order to monitor urine output.
A nasogastric (NG) tube should be placed in patients with burns involving 20% or more TBSA in order to prevent gastric distention and emesis associated.

Remember that this fluid management formula is only a guideline.   Furthermore, this fluid regimen does not include normal maintenance fluids.   Fluid management must be individualized.  Additional parameters for fluid management include urine output & systemic blood pressure. 

The 24 hour formula is
fluids for 24 hours = (4 х kg х  %burn) [2^nd & 3^rd added together]
with 1^st 50% of that total in the first 8 hours and the 2^nd 50% over the following 16 hours.

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Basics

Intravenous fluids may be used for:

Maintenance

 provide daily fluid requirement in patients unable to take in adequate fluids or losing increased amounts and correct dehydration

Use crystalloids to maintain volume.

A common regime (for an average 70kg man) to give 3 L fluid with 150 mmol sodium and 60 mmol potassium is:

·         1L normal saline with 20 mmol potassium over 8 hr

·         1L 5% dextrose with 20 mmol potassium over 8 hr

·         1L 5% dextrose with 20 mmol potassium over 8 hr

Other common regimes are:

·         1L normal saline with 20mmol potassium over 8hrs each and 1L of 5% dextrose with 20mmol potassium for patients with surgical problems (such as bowel obstruction) that may lead to excessive Na loss. Always check U+Es before prescribing

·         3x 1L of Hartmann’s solution over 8hrs each.  Hartmann's is physiologically close to plasma but has a lower osmolality. Continuous therapy can therefore reduce plasma osmolality and it should be avoided in patients with head injury to avoid exacerbating cerebral oedema.

A common regime to replace fluid loss requires several adjustments and close monitoring is:

·         250 ml colloid (Gelofusine) or 5% dextrose fluid challenge to maintain CVP at 8-12 cmH2O and BP >120 mmHg (repeat if necessary)

·         1 ml/kg/hr normal saline as adjunct fluid therapy

·         Additional potassium in 5% dextrose if K+ <3 mmol/L

Severe hemorrhage requires packed red blood cell infusion.

Hartmann’s solution at 20-30 ml/kg/hr can also be used for fluid resuscitation

Fluid and electrolyte balance

Daily requirements

·         Water: 40 ml/kg/day (rough estimation, see below for exact calculation)

·         Sodium ~ 100 mmol

·         Potassium ~60 mmol

Maintenance fluid requirement for healthy nil-by-mouth patient:

·         4 ml/kg/hr for first 10 kg of patient’s weight

·         2 ml/kg/hr for second 10 kg of patient’s weight

·         1 ml/kg/hr for every kg after that

·         + 100 mM sodium and 60 mM potassium

·         Fluid requirements in resuscitation depends on stages of hypovolemic shock:

·          

·         Stage 1 (< 15% or <750ml loss):  Normal blood pressure as compensated by increased systemic vascular resistance --> give Crystalloid

·         Stage 2 (15-30% or 750-1500ml):  Tachycardia, postural hypotension, +/- sweating and anxiety – partially compensated by increased systemic vascular resistance --> give Colloid

·         Stage 3 (30-40% or 1500-2000ml):  Systolic blood pressure <100 mmHg, tachycardia, tachypnoea, altered mental state (confusion) --> give Colloid + Blood

·         Stage 4 (>40% or >2000ml):  Very low blood pressure, bradycardia, weak pulse pressure, depressed mental state, urine output

·         negligible --> give Colloid + Blood