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Background: Malnutrition increase risk of postoperative complications leading to myriad of clinical consequences and prolong hospital stay. ERAS (Enhanced Recovery after Surgery) protocols are multimodal perioperative care designed to achieve early recovery through preoperative counseling and optimization of nutrition. We report a case of sigmoid volvulus patient who was planned for sigmoid colectomy.
Client History: Patient was 80 years old, Chinese man with underlying hypertension. He was admitted due to abdominal pain and BNO for one week, reduced food intake for 2 weeks and LOW for 2 months.
Assessment: His height and weight were 1.70m and 63kg, respectively with BMI of 21.8kg/m². Biochemical data showed low albumin, total protein, and deranged electrolytes. Patient was mild-moderately malnourished (SGA-B). Diet history indicated intake less than 200kcal (12%) and 6g protein (6%) from the requirement.
Nutrition Diagnosis: Inadequate protein-energy intake related to physiological causes increasing nutrient needs as evidence by 12% and 6% from energy and protein requirement.
Objective: To provide adequate energy and protein intake for nutritional status enhancement in mild-moderately malnourished patient undergone surgery.
Nutrition Prescription: Energy and protein prescribed were 1650kcal (25kcal/kg IBW) and 79g protein (1.2g/kg IBW). Combination of 60% from PN and 40% from ONS (standard and protein supplements) were implemented. Nutrition prescription adjustment was made by providing 50% from solid foods and another 50% from ONS one week before surgery. Patient was educated on the importance of nutrient optimization prior to surgery.
Monitoring & Evaluation: Patient was able to increase 66% and 57% of energy and protein requirement before surgery. One week later, sigmoid colectomy was done successfully. Patient was prescribed with ONS within 24-hours of post-colectomy, achieving 31% and 20% of energy and protein requirement. His weight was maintained, good vital signs and ambulation. He was discharged at post-operative day 2 in view of improving total protein, albumin and electrolytes.
Learning Points: Dietitian plays a key role in multidisciplinary ERAS protocol implementation. Pre-post nutrition management as stated in ERAS protocol helps to ease recovery, shorten hospital stays, reduce medical complications and enhance nutritional status in mild-moderately malnourished patient undergone surgery.
Disclosure statement: None