Question

Mr He was recently diagnosed with tonsillar cancer. Prior to starting his radiation therapy to treat the cancer, he had a PEG placed. He has completed 25 out of 35 treatments of radiation. In the past few to begin the PEG for TF. The home health care team will provide hib. Recommend a TF prescription for Mr X. Write the actual prescription- show your calculations. Explain your reasoning. (5 Points)

c. Name 3 things you'd look for to see if

d. wr statement for M

Answer 1

I will consider providing Mr.X with bolus feeling

This mode of feeding involves providing 200-400ml of feed. It is administered over 15- 30mins

1. Energy - The feed should provide around 35 kcal/kg/day
   1. This high amount of calories is essential because malignancy increases the body's metabolism and there is weight loss
   2. However, I will start with 15 -20 kcal/kg/day and gradually increase it to 35kcal/kg/day. This is to prevent refeeding syndrome.
2. Protein requirements
   1. 1.5 to 2.5 g/ kg of protein.
   2. This is more as compared to a healthy individual. The catabolic state of malignancy is associated with profound protein loss. Therefore the protein requirements are high
3. Fluid - 30 - 40 ml/kg/day of fluid
4. Electrolytes - Most feeds have adequate amounts of electrolytes
   1. Sodium - Patients with high metabolism have high levels of sodium. Therefore, I will restrict sodium intake.
   2. Potassium - Potassium levels need to be monitored. Hypokalemia is an important problem with the re-feeding syndrome.
   3. The magnesium level should be also monitored. Patients with hypomagnesemia have higher potassium losses.
   4. Phosphate requirement is 0.3mmol/kg/day
5. Micronutrients - Most feeds are fortified with micronutrients. However ever an individualized approach is required.