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Wa0003
Wa0003
Mrs GK (54 years old) was admitted to hospital with fever and leg cellulitis.
Previous Medical History includes: Diabetes – type 2, on insulin, IHD, CABG x 3 in
1995, AMI 2002, HT, CCF, hypercholesterolaemia, OSA.
Social Hx – lives with husband, enjoys watching TV. Not very active.
5 days later she is admitted to ICU with respiratory failure, sepsis and hypotension.
Anthropometry
Weight 115 kg
Height 160 cm
Weight history – Gradual weight gain over past few years.
Biochemistry
Na 138 mmol/L (N 134 – 145)
K 4.1 mmol/L (N 3.5 – 5)
Urea 9.2 mmol/L (N 3.0 – 8.0)
Creatinine 0.11 mmol/L (N 0.05 – 0.09)
Albumin 28 g/L (N 40 - 50)
WCC 12.4 (N 4 – 10)
Clinical
Intubated and ventilated
Temperature 38.5 C
NGT insitu
Hypotensive
Requiring inotropic support – Noradrenaline infusion
Nutrition History
Unable to take diet history due to communication limitations but patient indicates
usual good appetite and oral intake
You are referred to see the patient for nutritional assessment and appropriate
nutritional support.
What do you think of her nutritional status?
Calculate her estimated energy and protein requirements
Would you use enteral or parenteral nutrition?
Select the appropriate formula and determine your feeding regime.
The nursing staff are checking her NG aspirates every 4 hours. They
report that her most recent NG aspirate was
> 200 ml.
What would you do?
5 days later:
Temperature 38.4 °C
Oliguric
Hypotensive –increased noradrenaline requirements
Pulmonary oedema
Biochemistry:
Na 135, K 5.6, Urea 19.1, Creatinine 0.389
She is commenced on CVVHD.
Would you make any changes to your feeding regime? (Would another
formula be more appropriate?)
Issues to consider:
Fluid overload due to oliguria
High K levels
Choose Nepro
Nepro @ 50 ml/hr over 24 hr/day (1200 ml)
Provides 2160 kcal, 97g protein, 32 mmol K.
Calculation of Energy and Protein Requirements:
Weight = 115kg
Adjusted Body Weight = 64 + 0.5 x (115 – 64) = 90 kg
Energy
Schofield equation:
Protein
Moderate stress 1 – 1.5 g / kg BW / day
Isosource HN
1.2 kcal / ml
53 g protein / L
Therefore,
Need 1666 ml to meet energy requirements (2000 / 1.2)
If fed continuously over 24hrs
Rate = 1666 / 24 = 69 ml / hr