Reference no: EM133983280

Question

27 y.o. male presents with acute on chronic pancreatitis. He has had multiple readmissions over the prior 9 months, including a failed attempt of conservative management of bowel rest and NPO status. Since admission he has trialed a low-fat (50 g) diet which he was unable to tolerate d/t intractable N/V. The patient characterizes his abdominal pain as diffuse and concentrated in the epigastric region. Abd CT revealed mild pelvic ascites, moderate hepatic steatosis, and pancreatitis involving the tail. Abd US negative for gallstones. Abd MRI significant for walled off necrosis in the pararenal and perinephric space with pancreatic duct stricture. Surgery has been consulted and is recommending distal pancreatectomy and splenectomy with PEG placement.

During your initial nutrition assessment, the patient confirms he has attempted to eat in the last several weeks but continues with routine emesis. He has had a generalized depressed appetite for 8-9 months. Reports no PO intake for 7+ days. No BM x7 days. UBW of 166 lb prior to the onset of his illness (~9 months ago). His current standing wt on file is 124 lb. He has NKFA. Per your NFPE findings the pt is positive for scooping depressions at the temples, with prominent bones at the scapula, clavicle, and acromion bone. You also identify depression at the interosseous muscles.

1. Calculated BMI, as well as estimated energy requirements for calories, protein, and fluid.

2. Does this patient qualify for malnutrition? Include your criteria.

3. Do you recommend initiation of nutrition support and what specific route would you recommend?

4. What do you believe is the most appropriate provision of glucose (or dextrose) in grams on day one?

5. What specific lab values would you like to trend and how frequently?

6. Lastly, what language would you use to communicate to the patient your plan of care?