Begin by establishing a total fluid goal for the patient: evaluate current fluid balance by physical exam, I/O and labs calculate maintenance fluid requirements using standard guidelines take into account any fluid restrictions (cardiac/renal disease, BPD) Next determine how much of total daily fluid can be given as TPN. Take into account ALL fluids given - medications, piggybacks, IV drips and any enteral feeds. Subtract these from the total daily fluid amount and the remainder is what can be given as TPN. Pharmacy will automatically adjust the actual total TPN fluid amount for the IV tubing and residual volume while keeping the macro- and micro-nutrients as ordered. If the patient is dehydrated this should be addressed with isotonic fluids. Do NOT try to correct for fluid deficits with TPN. Fluid errors are the most common mistakes made when ordering TPN and can be inadvertently perpetuated. Be careful and recalculate fluids daily!!