Question

Adam is a 68-year-old male admitted to the hospital with a 1-month history of nausea, vomiting, and diarrhea resulting in weight loss and fatigue. He presents tachycardic with abdominal pain, fever, and chills. Adam is a retired engineer and lives at home with his wife

On hospital day (HD) 3, you visit Adam and learn that he has been NPO since admission due to his medical GI evaluation. Because Adam is feeling better and his GI symptoms have resolved, the medical team has just advanced Adam to a regular diet. Adam reports an excellent appetite and is looking forward to eating.

Anthropometric Data:
Weight: 73 kg (161 lbs)
Last weight: 75 kg (165 lbs) at admission

Biochemical Data: (HD 3)
Sodium 134 (135-145 mEq/L) Glucose 95 (70-139 mg/dL)
Potassium 3.3 (3.6-5.0 mEq/L) Phosphorus 2.9 (2.7 - 4.5 mg/dL)
Blood Urea Nitrogen 22 (6-24 mg/dL) Magnesium 1.4 (1.3 - 2.1 mEq/L)
Creatinine 0.2 (0.4-1.3 mg/dL)

Clinical Data:
Medications: protonix, lipitor, captopril

Dietary Data:
Diet Prescription: Regular

Questions
1. Is Adam at risk for refeeding syndrome? Explain.





2. What biochemical indices should be monitored with refeeding syndrome?






3. What factors mediate the refeeding process?




4. Do you have any recommendations for interventions for Adam?

Answer 1

Answer : 1) yes , Adam is risk for refeeding sundrome because he is starved for several days and prone for metabolic disturbances .

Refeeding syndrome : refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved , severely malnourished or metabolically stressed due to severe illness .

2) it is very important to monitor the serum concentration of potassium and phosphorous and megnesium .

Close monitoring of blood biochemistry in early 4 to seven days of restarting of food to patient because there is high synthesis of glucose ,proteins and fats .

Monitor the serum electrolytes reveals the disturbance in intake and metabolism

3) risk favtors :

Body mass index under 16

Interventional factors

Organisational factors

Interpersonal patient / family factors

Systemic diseases

Other illness

4) interventions :

Initiate the feeding with oral liquids in a small amounts then semisolids and solids according patient capability

Provide intravenous infusions if required .

• As a health care provider ,We need to monitor the patient clearly for complications .
• Monitor the serum electrolytes to know the deficiency or excess of electrolytes .
• Check the vital signs
• Encourage the patient to take small meals in frequent intervals .
• Educate the patient about importance of diet in order to prevent complications.
• Close monitoring of patient who are having cardiac risk .
• Educate the patient to avoid alcohol consumption ,smoking etc.