BACKGROUND
A teenager, involved in an accident which resulted in sudden alteration of energy and protein intake as well as unusual mode of feeding as compared to his normal routine. Other than that, there are differences in assessing and managing cases involving teenagers as compared to adult and children.
CLIENT HISTORY
Patient is a 14 years old Malay male high-schooler. He stayed with adoptive family. He was involved in an alleged MVA, diagnosed with severe TBI with underlying bronchial asthma. The accident happened when patient ran through red light while riding motorcycle and was hit by a car.
ASSESSMENT
Estimated height from knee height (50cm) is 165cm while estimated weight, plotted from growth chart at 55kg. Patient tolerated nasogastric, cyclic-pump feeding on morning of visit at 120cc Isosource. He was then kept for NBM for CT scan. His energy and protein intake were inadequate, plus the use of Isosource is unsuitable.
NUTRITION DIAGNOSIS
Inadequate energy intake(NI-2.1) related to feeding regime not yet prescribed as evidenced by current energy intake is 0 kcal compared to requirement 1615kcal and protein intake is 0g compared to requirement 82.5–110g
OBJECTIVE OF MANAGEMENT & NUTRIENT PRESCRIPTION
Energy prescribed is at 1619kcal (White, 2000) considering patient which is currently ventilated and haemodynamically supported, thus it is crucial to not overfeed the patient. Meanwhile, protein prescription at 1.5-2.0g/kg (Carol Parkman, 1998) is suitable for patient’s condition which is growing, experiencing trauma, has multiple fractures and wound. Management include replacing EN formula to Osmolite
OUTCOME & FOLLOW-UP
In 6 days of hospitalization, three follow-ups were managed. The energy intake shows increment from 0% ->8%->19%->37%, similar with protein intake; 0%->7%->19%->40%. The slow progression is due to patient was NBM for procedures and transition of feeding mode
LEARNING POINTS
• Adequate energy intake was unable to be received in targeted time due to procedures, thus, discussion with the medical team is necessary.
• Since patient has not yet received adequate energy and protein intake, providing continuation of care is important despite patient is being discharged without fulfilling the plan yet
• Although dietitian’s engagement seems minor, it helps in patient’s gradual recovery. Patient’s biochemical data improved although the intake of energy and protein were inadequate.
