Syarifah Hasanah Adeila Binti Hassan1, Siti Norhana Abd Wahid 1, Sarah Khalilah Kasa 2
1 Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur
2 Department of Dietetics and Food Service, Hospital Tuanku Ja'afar, Negeri Sembilan
SN, a 61 year old, Indian Male, was admitted for hypertensive emergency with orthostatic pneumonia, uncontrolled type 2 diabetes mellitus and post traumatic brain injury cognitive disorder. He also presented with underlying conditions of diabetes mellitus, hypertension, dyslipidemia and Ischemic Heart Disease. The initial assessments revealed findings of dysphagia, swallowing difficulty, poor dentition, decreased appetite and overall SGA categorisation of severely malnourished. Prior to admission, he was on an oral intake and upon admission due to semi-consciousness, Ryle’s Tube was inserted and a step-up regime was started on Nutren Diabetik - both intakes were below 75% of energy and protein requirements.
Inadequate protein-energy intake related to decreased ability to consume sufficient protein & energy as evidenced by diet recall of 864kcal and 38.7g protein vs requirement of 1600kcal and 65 g of protein.
The objective was to provide adequate protein and energy in order to prevent further progression of malnutrition. The nutrient prescription continued the Ryle’s Tube with an increased energy and protein target.
Monitoring & Evaluation
The monitoring & evaluation parameters for SN included assessing his total energy & protein intake as well as his tolerance (Vomit, Bowel Output, Abdominal Distension, Aspiration) to the prescribed regime. Additionally, SN’s long term progression will be monitored through his weight trend as well as physical examination of muscle and fat stores.