To calculate the NPCs, subtract the protein calories from the total daily calories. Do not start at your total goal calories. Instead start at about 1/3 of the total non-protein calories and advance over 3 days to full calories. Most patients will have clinical intolerance - hyperglycemia, hypertriglyceridemia, electrolyte imbalance - if started at goal calories on day one. This is especially important the more critically ill the patient is. As an example, consider a 9-year-old critically ill patient who weighs 30 kg. Using the recommended guidelines we get a figure of 70 Kcal/kg/day or a total caloric requirement of 2100 Kcal/day for this patient. Using the protein table we get a figure of 1.5-2 gm/kg/d. If we use the upper limit, we have 60 gm protein/day (30 kg x 2 gm/kg/d) or 240 protein calories/day (4 x 2 gm/kg x 30 kg). Subtracting the two gives us 1860 NPCs/day for this patient. On day one we would start with about 600 NPCs.