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Nutrition provides exogenous fuels to support critically ill patients during the stress response to preserve lean body mass and maintain immune function. In this case, the patient is a 75 years old Chinese lady who was admitted for vertebral fracture after falling on her buttocks. She had developed progressive abdominal distention and worsening renal profile in ward. Upon transfer to ICU, she was diagnosed with hospital acquired pneumonia; AKI on CKD; large bowel pseudo-obstruction; T11-C2 fracture; with underlying diabetes mellitus; ascending colon polyps and descending colon diverticulum. The patient was underweight and edematous. She had minimal urine output, was ventilated and sedated. Her biochemical data shows increasing trend of urea and creatinine, with low albumin and hemoglobin level. She was kept NBM and given dextrose saline intravenously. Nutrition Diagnosis is inadequate energy intake related to patient kept NBM as evidenced by diet history (31% of energy requirement achieved from IV drip). The goal of nutrition support in this case is to prevent malnutrition, ultimately to preserve lean body mass. Initially she was deemed not yet suitable for enteral nutrition (EN) and thus provided with Nutriflex Lipid Special, a calorie-dense parenteral nutrition (PN) available at the hospital, to minimise fluid accumulation due to her minimal urine output. After her intestinal problem was resolved, EN was immediately provided to preserve gut integrity and she was given Novasource Renal, a calorie-dense formula in view of her worsening renal profile and minimal urine output, and her PN was stopped. Eventually her CGS improved and she was able to take the product orally. From this case, we can learn that assessments of patients' conditions before feeding, collaboration with other healthcare providers and continuous monitoring as well as individualized nutrition care may help in bringing positive outcomes to the patients.