Section 4 - TPN case studies

Section 5 - TPN case studies

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Case 1

A.M. is an 66 year old woman who was admitted with complete bowel obstruction, multiple adhesions, and recurrent Crohn's disease. She is 65 inches tall and weighs 65 kg with a usual weight of 75 kg. Her medical history includes Crohn's disease and type II diabetes. An exploratory lap is scheduled, and lysis of adhesions and small bowel resection to remove diseased bowel are performed.

Pertinent admission labs

Value Normal
BUN 7 mg/dl 5 to 25 mg/dl
Creatinine 1.2 mg/dl 0.5 to 1.5 mg/dl
Sodium 141 mEq/dl 135 to 145 mEq/dl
Magnesium 1.6 mEq/dl 1.8 to 2.2 mEq/dl
Phosphorus 1.8 mg/dl 2.5 to 4.5 mg/dl
Prealbumin 5 mg/dl 16 to 40 mg/dl
Transferrin 105 mg/dl 250 to 300 mg/dl

**Pertinent admission labs**
	Value	Normal
BUN	7 mg/dl	5 to 25 mg/dl
Creatinine	1.2 mg/dl	0.5 to 1.5 mg/dl
Sodium	141 mEq/dl	135 to 145 mEq/dl
Magnesium	1.6 mEq/dl	1.8 to 2.2 mEq/dl
Phosphorus	1.8 mg/dl	2.5 to 4.5 mg/dl
Prealbumin	5 mg/dl	16 to 40 mg/dl
Transferrin	105 mg/dl	250 to 300 mg/dl

Assessment
Because her visceral proteins indicate moderate depletion and she has lost 10% of her usual weight, nutritional support is indicated. What are her initial estimated calorie, protein, and fluid requirements?

Her GI tract is not expected to accessible for at least 10 - 14 days. Which type of nutritional support is best for this patient?

Complications
What metabolic problem is he at risk of developing?

How can the risk of this problem be decreased?

When can the PN be advanced to goal infusion rate?

Section 5 - TPN case studies