A 22-year-old female who has sustained a 50% total body surface area burn in a house fire is intubated in the ICU. She is scheduled for serial debridements in the OR. The best management for perioperative nutrition includes:
Correct Answer: B
A metaanalysis in 2003 did not find a decreased risk for aspiration with prolonged NPO. Protein-calorie malnutrition has been linked to worse outcomes with respect to ventilator-free days, ICU and hospital LOS, wound healing, and mortality. Continuing tube feeds despite trips to the OR is the best choice for nutrition management in this scenario. There is no indication to initiate TPN at this time.
References:
A 39-year-old 80-kg trauma patient is intubated and sedated in the ICU. You are planning to start enteral nutrition.
What is his daily calorie goal that you need to meet with tube feeding?
Correct Answer: A
The American Society of Enteral and Parenteral Nutrition recommends the usage of a simple formula to predict calorie needs when indirect calorimetry is not available. Using 25 to 30 kcal/kg/d with the patient’s dry or usual body weight allows easy calculation of an appropriate calorie range.
Reference:
Which of the following patients should have enteral nutrition advanced to goal within the first 24 to 48 hours of hospitalization instead of waiting up to 1 week before instituting enteral nutrition?
Correct Answer: C
The American Society of Enteral and Parenteral Nutrition recommends that patients with a NUTRIC score ≥5 should be rapidly advanced to goal enteral nutrition within the first 24 to 48 hours. NUTRIC scores are based on age, comorbidities, APACHE score, SOFA score, and days from hospital to ICU admission (IL-6 level can also be included if available).
A patient’s calculated nitrogen balance is 4 g/d. What change to the patient’s nutrition would you make?
Calculating the nitrogen balance requires a 24-hour urine collection and can be derived using the following formula: (total protein intake [g/d]/6.25) − (urinary urea nitrogen − 4). A standard goal for nitrogen balance is (+) 4 to 6 g/d.
A frail appearing 82-year-old male is admitted to the ICU with respiratory insufficiency due to pneumonia. A nasogastric tube is placed as there are concerns for dysphagia and tube feeds are started. Approximately 24 hours after admission the patient develops signs and symptoms of left heart failure. The most likely cause of this patient’s sudden cardiac dysfunction is:
Elderly patients are particularly at risk for refeeding syndrome owing to unrecognized under nutrition. The electrolyte abnormalities that accompany refeeding syndrome include hypophosphatemia, hypomagnesemia, hypokalemia, and thiamine deficiency. All of the above are depleted during periods of malnutrition, but plasma levels drop precipitously when the body switches from catabolism during starvation to anabolism during refeeding. Cor pulmonale and pulmonary embolism are unlikely as this patient has evidence of left ventricle dysfunction. Niacin (vitamin B3) deficiency is associated with rash, vomiting/diarrhea, and dementia.
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