Nurul Aqilah binti Hasan Ashaari1, Jazlina binti Syahrul1, Zalina Abu Zaid1, Lina binti Isnin2
1Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
2Hospital Melaka, KKM
Patient 54 years old, Malay woman, a housewife. Diagnosed with mixed 5% dermal burns over at right upper limb and back and admitted to Burn Unit after surgery of tangential excision and skin graft procedures. Was referred to dietitian on Post Operation Day 3. For anthropometry data, she was at normal BMI (24.4kg/m2). Dosing weight used @current weight, 55kg. Patient has underlying of hypertension and epilepsy. Patient was hemodynamically stable under room air. Biochemically the values of hemoglobin, total protein and albumin are at abnormal level. The nutrition intake of the patient was 39-48% energy adequacy and 0.4g/kg BW protein. Patient reported of early satiety with poor appetite.
Inadequate protein energy intake related to increased nutrient needs due to burn as evidence by diet history (39-48% energy, 0.4g/kg/BW protein adequacy) and biochemical data (Hb <13, total protein <66, albumin <33) and poor appetite.
To achieve adequate energy and protein for better wound healing and shorten the length of stay. The energy prescribed ranged from 1550-1925kcal/d@30-35kcal/BW with protein requirement of 1.5g/kg/BW. The plan: to optimize patients’ intake by encouraging orally as tolerated of high protein with low salt diet and supplement patient with standard polymeric formula with additional liquid high protein supplement with collagen. Counselling was given to encourage patient to finish her diet and ONS given. Estimated energy and protein from the plan was 1625kcal, 83g respectively(84-100% adequacy).
Monitoring & Evaluation
Total energy achieved at 77% energy achieved with 0.8g/kg/BW protein. To achieve adequacy 100%, the plan remains for next follow-up. From nutrition management, we can see significant improvement from nutrition intake (>70% energy achieved) and shorten patients’ stay (discharged at day 9) with no complications reported. Adequate and prompt nutrition (high energy, high protein) is important in to compensate heat loss from wound and to ensuring faster recovery.