MetabolisminSurgicalPatientsDr.FernandoL.Lopez Case#1: Apreviouslyhealthy75y/omalewasadmittedtothehospitaltendaysagoduetoanepisodeof diverticulitis.ForthreedaysthepatientwasunderorderstoremainNPO,bythetimefoodwasreintroduced, hewasanorexic.Overthelastsevendayshehashadprimarilyliquidfoods.Heisnotvomitingandhisstool hasnormalconsistency.Thepatientreportedthathehaddiarrheaforfivedayspriortohisadmissiontothe hospital.Beforebeinghospitalized,heweighed78kg,withoutobviousfluctuations.Onphysicalexamination heshowednochangesinbodycomposition,althoughhisweightdroppedto66kg. Diagnosis: SubjectiveGlobalAssessmentofNutritionalStatus A. History 1.

1.Weightchange Overalllossinpast6months:____kg Percentloss__________________ Changeinpast2weeks:_____increase_____nochange____decrease 2.Dietaryintakechangerelativetonormal Nochange_____ Change:duration_____weeks____days Type:suboptimalsoliddiet____fullliquiddiet_____hypocaloricliquiddiet____starvation___ 3.Gastrointestinalsymptoms(persistingmorethan2weeks) None_____Nausea_____Vomiting_____Diarrhea___Anorexia____ 4.Functionalcapacity Nodysfunction_____ Dysfunction:duration_____weeks_____months Type:workingsuboptimally_____ambulatory_____bedridden_____ 5.Diseaseanditsrelationshiptonutritionalrequirements Primarydiagnosis:_________________ Metabolicdemand/Stress:none_____low_____moderate____high_____ B. PhysicalExamination (foreachspecify:0=normal,1+=mild,2+=moderate,3+=severe) Lossofsubcutaneousfat(triceps,chest)______ Musclewasting(quadriceps,deltoids)______ Ankleedema____Sacraledema____Ascites____ C. SubjectiveGlobalAssessmentRating Wellnourished A.________ Moderately(orsuspectedofbeing)malnourished B.________ Severelymalnourished C.________

Case#2: B.C.,a40y/owhitemale,isadmittedtothehospitalwithmultipletraumafollowingamotorvehicle accident.Thepatientishemodynamicallystablefollowingfluidresuscitationandanasogastric(NG)suction tubeisplacedduetothepresenceofgastricileus.Drainageisapproximately1.2L/day.Thereisnosignificant organdysfunction.Hisbodyweightpriortoinjurywas70kg,andhisheightis175cm(BMI=22.8).The followingbiochemicaltestswerecompletedfourdaysaftertheaccident: Serumsodium,mEq/L 135 (normal=135145) Serumpotassium,mEq/L 4.8 (normal=3.75.0) BUN,mg/dL 25 (normal=525) Glucose,md/dL 130 (normal=80110) ENERGY TotalDailyEnergyRequirementsbytheQuickmethod&HarrisBenedictmethod WATER TotalDailyWaterRequirements PROTEIN TotalDailyProteinRequirements CARBOHYDRATE TotalDailyCarbohydrateRequirements FAT TotalDailyFatRequirements Whatrouteofdeliverywouldyouchooseandwhy?(giveadvantages&disadvantages)