Suraya A1, Norhaishah H1
1Universiti Kebangsaan Malaysia (UKM)
A 62-years old married Malay male was diagnosed with bladder cancer on September 2017 and had undergone multiple transurethral resection of bladder (TURB) procedures (5 times). Patient developed hematuria for the past 2 months and was worsening with blood clots for the past 4 days. He was admitted to Hospital Canselor Tuanku Muhriz (HCTM) on 30th March 2021 with impression of hematuria secondary to bleeding bladder cancer with symptomatic anemia. Radical cystectomy is going to be performed on patient on 22th April 2021 and he was referred for pre-operation nutrition optimization. Patient has normal BMI of 20.0 kg/m2. He experienced insignificant weight loss of 0.5% in 2 weeks. The weight reduction was indicated by suboptimal energy intake at only 50% of estimated energy requirement and protein intake of only 6g/d due to loss of appetite since admission. Patient’s SGA was graded as B.
Inadequate protein-energy intake related to loss of appetite as evidenced by estimated energy and protein intake only achieved 50% and less than 10% of estimated requirement respectively.
Nutritional intervention aimed at achieving at least 75% of energy requirement and protein 1.2 – 2.0g/kg/d. ONS was suggested to the patient as one of the strategies to increase protein-energy intake (40% from requirement). Nutrition counselling to the patient and family members regarding the importance of increasing protein-energy intake was also conducted. Diet modification such as high protein and proper texture was also included as strategies.
Monitoring & Evaluation
To monitor weight changes in a week and oral intake daily. Follow-up: Patient achieved 122% energy requirement. Protein intake improved from 6g/day to 61g at 0.9g/kg/d. Patient was encouraged to continue on maintaining energy intake and was motivated to increase the protein intake. Lesson learnt: in patients necessitate for surgery, perioperative maintenance of nutritional state is important in order to prevent postoperative complications.