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PATIENT PRESENTATION

Chief Complaint

“I’m having severe abdominal pain and cramping, bloody diarrhea, and haven’t been able to eat for a week.”

History of Present Illness

GH is a 58-year-old man who presented 7 days ago with a month-long history of worsening abdominal pain and cramping, diarrhea, and loss of appetite. During the week prior to admission, his diarrhea became bloody, he developed fevers, and has had minimal nutrition. After initial attempts at medical treatment, he underwent an extensive bowel resection for a severe Crohn’s disease flare yesterday.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. Does this patient have an appropriate indication for PN therapy?

    Hint: See Introduction, Table 1, and references 1 and 2 in Chapter 100 in PPP

  2. Is this patient at risk of refeeding syndrome? If so, why? If not, why not?

    Hint: See Complications of PN and references 37-39 in Chapter 100 in PPP

  3. What signs, symptoms, and laboratory abnormalities are possible manifestations of refeeding syndrome?

    Hint: See Complications of PN and references 37-39 in Chapter 100 in PPP

  4. What steps would you take to prevent refeeding syndrome in this patient?

    Hint: See Complications of PN and references 37-39 in Chapter 100 in PPP

  5. Does this patient have an indication for an alternative lipid emulsion? If so, what indications and which product would you select?

    Hint: See PN Components, Table 100-2, and reference 8 in Chapter 100 in PPP

FOLLOW-UP

What recommendations would you have about initiating PN in this patient? Develop a goal PN regimen, as well as a plan to initiate PN, advance PN to goal, and monitor PN therapy while in the hospital.

CASE SUMMARY

Global Perspective

The refeeding syndrome is a constellation of metabolic derangements that can occur in patients who are malnourished or who have had a prolonged period of inadequate nutrition with significant weight loss. Refeeding syndrome can lead to serious complications, including death (although rare), and it can be one of the few true emergencies associated with nutrition therapy. In developing countries or areas where malnutrition is prevalent and nutrient and vitamin deficiencies are common, refeeding syndrome could be a significant concern if the person were to receive a more abundant source of nutrition (oral or ...

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