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How Hyperalimentation May Be Necessary to Reverse Severe Malnutrition in Selected Patients Receiving Home Parenteral Nutrition
Author(s) -
Edakkanambeth Varayil Jithinraj,
Hurt Ryan T.,
Kelly Darlene G.
Publication year - 2014
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533614522833
Subject(s) - medicine , parenteral nutrition , malnutrition , intensive care medicine , pediatrics
Standard predictive equations may under‐ or overestimate caloric requirements in disease states such as obesity or in patients with a low body mass index (BMI). Although this principle is common knowledge among nutrition specialists, it is often not prioritized with other clinicians outside the intensive care unit (ICU). Indirect calorimetry (IC) is often used in the ICU to estimate caloric requirements. This article outlines a very complicated case of a cachectic man with an enterocutaneous fistula who had lost more than 50% of body weight over 2 years. In rehabilitating this patient, we found that the most common formulas of basal needs greatly underestimated the calories required to prepare him for restorative surgery. Key learning points are that in malnourished ambulatory patients, predictive equations may not adequately estimate caloric needs and IC may be required.