Question

RS is a 67-year-old man who you are asked to see for nutrition support following repair of abdominal aortic aneurysm six days ago. He presented to the hospital two days earlier with intense abdominal pain that was unrelated to meals or physical activity. He had been receiving medical care for a longstanding history of hypertension. He has a 75- pack/yr history of tobacco use. Surgery proceeds without difficulty except for one episode of hypotension that is readily managed with IV fluids. He is admitted to the intensive care unit (ICU) on a low dose of dopamine to promote optimal renal perfusion. Intubation is required and broad spectrum antibiotics are begun on the 4th postoperative day when he develops respiratory distress and a fever of 103 degrees Fo. Urine output is Ooted to decrease soon after and there is no improvement despite administration of IV fluid and furosemide. RS was eating normally prior to surgery, but has not had any nutrition for 8 days. His nutritional parameters are as follows: height- 175.3 cm, weight-79.3 kg, usual weight - 75 kg and ideal weight-72 kg. His abdomen is distended, tympanic to percussion, and without bowel sounds on auscultation. Review of his intake and output record shows that over the last 24 hours there has been 1400 mL removed from his nasogastric (NG) tube and a urine volume of only 300 mL, despite an intake of 4200 mL of IV fluids. A plain film with cross table view of the abdomen shows dilated loops of small and large bowel with air-fluid levels in the small bowel. Laboratory values are as follows: potassium -5.2 mEqL BUN 38 mg/d, Cr 46 mg/dl, and albumin 2.3 g/d. Other laboratory values are normal. QUESTIONS: Does this patient need nutrition support? Why or why not? If so, what type, PN or EN?

Answer 1

RS is need of nutrition at this time because its his 8th post op day by this time patients are able to eat solid food, in his vase there is no bowel movements so an oral feed cannot be given .Parental nutrition to be chosen which will meet his nutrient requirements.

The PN solution should be as per the order,generally a central line has to be instilled because there are high chances for formation of peripheral clots during administration and leading to further complications.

A central line can be advanced

His blood sugar level as to be assessed as per the order because TPN elevates blood sugar level.

Fluid overload has to be assessed

Intake and output to be measured accurately.