Parenteral nutrition · evaluation release
Dōsys Parenteral Nutrition
Adult PN regimens with the arithmetic shown: energy, protein, dextrose, lipid, fluid and electrolytes in one view, with the calculation and source behind each check. This is an evaluation release for synthetic adult cases only. It has not completed independent clinical validation and is not for patient care.
PN is a high-alert therapy built from many small calculations
Parenteral nutrition appears on the ISMP list of high-alert medications. A single regimen combines weight selection, energy and protein targets, dextrose and lipid limits, fluid, electrolytes, compatibility, and route of administration — and every change ripples through the rest.
ASPEN’s national PN practice survey found PN ordering and review practices still vary widely, with many organizations relying on partial electronic support or manual steps. Many freely available calculators address macronutrients alone and leave electrolytes, peripheral suitability, non-nutritional calories, and documentation to the clinician.
Dōsys Parenteral Nutrition is being designed to close that gap without hiding the reasoning.
One workspace, from assessment to note
Patient data on one side, results on the other. Planned calculations will appear as soon as there is enough information — no long form to complete first.
Patient context
Height, weight, and clinical context that actually changes the calculation: ICU status, obesity, kidney replacement therapy, hepatic dysfunction, refeeding risk, fluid limits. Every input has a defined purpose.
Targets, with their basis
Energy and protein targets as ranges, the weight they were calculated from, the guideline framework used, and room for measured energy expenditure when indirect calorimetry is available.
The regimen, live
Dextrose, amino acids, lipid, volume, and electrolytes in one editable view. The planned workspace will recalculate dependent results after each edit.
Checks that explain themselves
Each warning states what was detected, why it matters, the calculation behind it, and its source — without telling you what you must order.
Documentation
An editable assessment note organized the way pharmacists and dietitians document PN: targets, macronutrients, fluid, electrolytes, micronutrients, monitoring, and safety considerations.
Change a value. See every consequence.
Adjust calories, protein, dextrose, lipid, electrolytes, volume, or infusion time and the planned workspace will recalculate dependent results. Suggestions and clinician-entered regimens will be shown separately, with a record of changes.
- kcal/kg/day and total kcal
- Protein g/kg/day
- Glucose infusion rate
- Lipid g/kg/day and infusion rate
- Non-protein calories and macronutrient distribution
- Estimated osmolarity, with the formula shown
- Final electrolyte concentrations
- Calories from propofol, dextrose-containing IV fluids, and enteral or oral intake
Safety checks, in four tiers
Four planned tiers will keep interruptions proportional to risk. Each alert is intended to include what was detected, why it matters, the calculation, the source, and possible clinical considerations.
Info
Context worth knowing. Never interrupts.
Caution
A value is outside a guideline range. Review suggested.
High risk
A combination associated with meaningful harm. Acknowledgment and a documented reason required to proceed.
Hard stop
Reserved for physically or chemically unsafe conditions and product-label maximums, not for clinical preferences.
Honest about evidence
Much of PN practice rests on expert consensus. Dōsys will not turn uncertain practice into an apparently precise number.
Where guidelines disagree, both are shown
Guideline frameworks differ on early ICU energy targets and obesity dosing. NICE, ASPEN and AuSPEN also differ in their refeeding approaches. Dōsys will show the framework behind each suggestion rather than silently choosing one.
Where newer evidence has moved
Several large randomized trials published since 2023 did not show benefit from higher protein doses in critically ill adults. Suggestions will identify when trial evidence post-dates guideline recommendations.
Where a formula would create false confidence
Calcium–phosphate solubility depends on the amino acid product and concentration, pH, temperature, salt form, and mixing, so no generic rule predicts it. The evaluation calculator therefore uses a published, product-specific model (Anderson 2022) and only for the amino acid products and conditions that model covers; outside them it declines to answer. A within-limit result is an empirical prediction, never laboratory confirmation, manufacturer verification, or authorization for patient use.
Where estimates have error
Predictive energy equations and osmolarity estimates carry real error. Results will name the method used and show that uncertainty rather than a falsely precise number.
Primary frameworks under review include ASPEN, ESPEN, SCCM, NICE, ISMP, and FDA product labeling. See the ESPEN guidelines, NICE CG32, and the 2025 AuSPEN refeeding consensus. Specific sources will be linked from each rule in the product.
Clear scope
Designed for
- Adult patients
- Central PN assessment, with peripheral limited to an osmolarity check against a user-entered limit
- Macronutrient, fluid, and electrolyte calculation
- Explainable safety checks with sources
- Editable clinical documentation
Not intended for
- Pediatric and neonatal PN (initial release)
- Compounding instructions or automated compounder output
- Emergent electrolyte replacement
- Replacing pharmacist order review or institutional protocols
Validated before it is used
Before clinical release, every equation will require individual software checks. A planned library of reference patients — including obesity, kidney replacement therapy, hepatic dysfunction, refeeding risk, fluid restriction, and peripheral PN — will be checked against independent expert calculations. The current protocol is a single-author draft by the founder, and independent clinical review is pending: nutrition support pharmacists, dietitians, and physicians will review the rules before clinical release, and methods and change logs will be published.
- Now
Research & specification
Evidence review, calculation and safety-rule specification, independent clinical review.
- Next
Adult PN workspace
Targets, live regimen editing, core safety checks, documentation. Early-access testing with reference cases.
- Later
Daily PN management
Yesterday’s bag vs. today’s labs vs. today’s proposal, with trends and a clear change summary.
- After that
Institutions
Local formularies and protocol limits, team workflows, and standards-based integration.
Roadmap stages are plans, not release dates, and may change based on clinical review.
Help shape Dōsys Parenteral Nutrition
We are looking for nutrition support pharmacists, dietitians, ICU pharmacists, and physicians who write or review PN to test workflows and review reference cases.
Dōsys products are clinical decision-support tools for qualified healthcare professionals and do not replace independent clinical judgment.