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Section 5 - Enteral nutrition case studies

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Case 1

M.L. is an 84 year old man who was admitted with a diagnosis of CVA. He is 70 inches tall and weighs 153 lbs with a usual weight of 180 lbs. His family reports that he has a long history of alcoholism. After the first 36 hours of admission, his voluntary intake is reported to be very poor. He is unable to communicate with caregivers and family and has marked difficulty swallowing.

Pertinent admission labs

Value Normal
BUN 42 mg/dl 5 to 25 mg/dl
Creatinine 1.9 mg/dl 0.5 to 1.5 mg/dl
Sodium 151 mEq/dl 135 to 145 mEq/dl
Potassium 5.1 mEq/dl 3.5 to 5.0 mEq/dl
Albumin 3.1 g/dl 3.5 to 5.0 g/dl

Assessment
What are his initial estimated calorie, protein, and fluid requirements?


Complications
Because he has lost 15% of his usual weight and is unable to swallow, an NG tube is inserted and feedings initiated with Isocal at 50 ml/hr to advance to 100 ml/hr as tolerated. M.L. then experiences abdominal distension and excess residuals at Isocal rates greater than 65 ml/hr.

What metabolic problem is he at risk of developing?

What mechanical problem is he at risk of experiencing?


Enteral Rx
Because of the abdominal distension and excess residuals, Isocal HCN is ordered at 65 ml/hr.

Does this latest order meet all of the patient's nutrition needs?

What is a better option at this point?

What is a long term solution?


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Section 5 - Enteral nutrition case studies

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