Advocating Dietitians Role in Managing Patient at Risk of Refeeding Syndrome with End Stage Renal Failure (ESRF): A Case Study

24 Jun 2019 10:40 10:50
Nur Adilah Bt Muhammadun Basar Presenter

Nur Adilah M.B., Zulfitri Azuan, M.D.
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia

Assessment: Background: Patient was 64 years old, Malay male with underlying ESRF on maintenance hemodialysis, Diabetes Mellitus, hypertension, and history of stroke 7 years ago.Following episodes of choking at home, patient was only tolerated fluid for the past 3 weeks and had been referred to dietitian to initiate Ryles tube feeding. Nutrition Assessment: Patient was identified as malnourished with BMI of 17.4kg/m2 and SGA score C. Biochemical data showed deranged electrolytes, low albumin, total protein and haemoglobin. Patient had only been fed with one bottle of renal disease specific formula per day for the past 3 weeks. Thus, we identified patient as at-risks of refeeding syndrome

Diagnosis: Malnutrition related to food- and nutrition-related knowledge deficit concerning amount of energy and protein needs as evidenced by BMI of 17.4kg/m2, SGA score C and estimated energy intake and protein intake achieved 21% and 28% from requirement

Intervention: Protocol for managing patient at risk of refeeding was executed with energy provision commenced at 10 kcal/actual kg/d. Suggestion to supplement patient with Thiamine and Vitamin B complex was performed.

Monitoring and Evaluation: Monitoring & Evaluation: Dietitians regime prescription was followed and well tolerated by patient. Family members decided to discharge patients at own risk and stop doing haemodialysis. Latest biochemical data show increasing trend of renal profile however, other sign and symptoms for refeeding syndrome were not apparent. Discharge prescription was maintained at current regime, which provided 22 kcal/kg ideal body weight/d and 1.0 g protein/kg ideal body weight/d. Learning Points: Proactive role of dietitian to identify and alert the multidisciplinary team on atrisk patient for refeeding syndrome is crucial to prevent its fatal consequences. Daily monitoring is paramount, not only based on electrolyte reading but also from other sign and symptoms of refeeding syndrome signifying nutrition focused physical examination (NFPE) role in dietetic practices.

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