Jing Wen N.1, Woan Yin T.2, Ying Ting E.1, Jazlina Syahrul.1, Zalina AZ.1
1 Department of Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia.
2 Department of Dietetics and Food Services, Hospital Melaka.
Middle cerebral artery infarct as an ischemic stroke that leads to poor cognitive and neurological function. Nutrition as part of rehabilitation interventions is important in restoring functional status of patient while enhancing neurocognitive recovery.
Mr T, 39-years-old, Chinese, male prisoner with underlying Hypertension since 29-years-old, referred for NGT feeding on his post craniectomy Day 3. Patient’s estimated height is 175 cm while IBW is 67 kg. Patient showed consistently high BP throughout all visits and scored SGA Grade A (physical examination). Sodium showed decreasing trend since POD3 and dropped to abnormal range during POD5. Possible causes including fluid overload, SIADH or low sodium intake. Patient did not achieve sufficient energy (21 %) and protein adequacy (0.2 g/kg/day) via NGT (standard polymeric formula) when patient started feeding on POD2. Feeding fluid restriction started on POD8.
Inadequate enteral nutrition infusion related to infusion volume not reached as evidenced by inadequate energy and protein adequacy. (Resolved after POD5)
Altered nutrition related laboratory value (sodium) related to underlying physiological conditions as evidenced by low sodium level.
Main objective was to achieve 70 – 75 % of energy (25-30 kcal/kg/day) and protein requirement (1.2-1.5 g/kg/day). Changes of enteral formula into standard polymeric RTD formula with high sodium level and feeding fluid restriction were initiated later to optimize sodium level while achieving sufficient nutrient adequacy.
Monitoring & Evaluation
After POD5, patient able to achieve more than 100% of energy and protein adequacy. Patient’s sodium level showed great improvement during POD11 (128 to 133 mmol/L).
Discussion: Initiating tube feeding among post-operative stroke patients with dysphagia can reduce risk of malnutrition when oral intake is insufficient. High energy and protein intake are essential in preserving muscle mass, preventing sarcopenic obesity, disability and physical impairment. Hyponatremia in stroke patient should be intervened to prevent deterioration of consciousness caused by neurological symptoms.