TITLE OF CASE
Multiple sclerosis, tracheoesophageal fistula, grade 2 sacral sore and chronic lung disease.
BACKGROUND
Nutrition intervention is important in optimizing nutritional status for better quality of life of long stayed hospitalized patient.
CLIENT HISTORY
Patient is a 27-years-old Chinese gentleman who was diagnosed multiple sclerosis 4 years ago, he developed tracheoesophageal fistula and chronic lung disease during hospital stay.
ASSESSMENT
Patient was severely underweight with body mass index (BMI) 13.7kg/m2. Low serum creatinine level indicated muscle wasting and low albumin level indicated that patient was in inflammatory condition. Patient was bed-ridden, ventilator-dependent and received feeding via gastrostomy tube. He experienced diarrhea with the change of semi-elemental formula (Peptamen to Semital), therefore feeding was changed back to Peptamen by own purchase. He had multiple feeding interruption his estimated intake during review only achieved 72% requirement and protein intake was achieved 100% requirement with added protein modular.
NUTRITION DIAGNOSIS
Enteral nutrition composition inconsistent with needs (NI-2.5) related to feeding intolerance toward enteral product (Semital) given as evidenced by patient experienced diarrhea (watery stool x7/day) and estimated energy intake only achieved 72% of requirement.
OBJECTIVE OF MANAGEMENT & NUTRITION PRESCRIPTION
Nutrition intervention aimed to provide adequate energy and protein to preserve muscle mass, optimize nutritional status and promote wound healing.
OUTCOME AND FOLLOW-UP
Patient tolerated feeding with Peptamen, no watery stool seen. Upon discharge, feeding was challenged with standard formula (Ensure) using feeding pump as patient had sensitive gut (frequently experienced abdominal bloated and diarrhea on feeding modification), followed by bolus feeding as per toleration. Patient tolerated well toward feeding as planned and he was discharged with standard formula bolus feeding regimen.
DISCUSSION
Weight gaining was slow as patient had undergone many medical procedures causing feeding was interrupted (Adam 2007). Adequate protein and energy are important to optimize patient’s nutritional status (Yang et al. 2004).
LEARNING POINTS/TAKE HOME MESSAGES
1. High energy and protein provision are important for multiple catabolic illness patient.
2. Continuous feeding can be initiated when changing new enteral products especially for sensitive gut patient.
