Nutrition

Published on 03/03/2015 by admin

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Last modified 03/03/2015

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3 Nutrition

Feeding the patient

Case history

A surgical colleague phones you to ask about parenteral nutrition for a 70-year-old man who had an oesophago-gastrectomy 5 days previously. Postoperative care had been straightforward and no prior provision for parenteral nutrition had been made. It now seems likely that he has an anastomotic leak.

What should you advise?

Parenteral nutrition is never an emergency therapy. It can always wait until expert advice is available next day. You say that you will bring your consultant along the following morning.

Remember

• It is better to predict (if possible) whether some form of supplementary nutrition is likely to be required before an event

• Over 10% of patients in hospital are said to be malnourished.

How do you assess the nutritional state?

This can be done simply by looking at the patient! Does he look malnourished? Other parameters that can help are:

• Weight loss > 10%

• Serum albumin < 35 g/L

• Serum transferrin < 1.5 g/L

• Body mass index (BMI) = (kg) ÷ height (m²); the normal range is 18.5 to 24.9.

An evaluation of the nutritional status can be done using the MUST criteria (Fig 3.1).

Figure 3.1 ‘Malnutrition Universal Screening Tool’ (‘MUST’).

Reproduced with permission from the British Association for Parenteral and Enteral Nutrition (BAPEN): www.bapen.org.uk.

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