Siti Nur Amirah Mohd Adnan.1, Jazlina S.1.
1Department of Dietetics, Hospital Pengajar Universiti Putra Malaysia, Universiti Putra Malaysia.
Case Presentation: A 61-year-old Chinese lady in a post stroke care, had undergone decompression craniotomy 2 months ago with underlying of HPT. The patient was re-admitted due to Hospital Acquired Pneumonia (HAP) and fast Atrial Fibrillation (AF) secondary to Hospital Anxiety Depression (HAD). Patient was presented with cardiac failure and referred for expert opinion for changes in enteral feeding due to ROF 1L/day.
Patient’s height and weight were 150cm and 50kg, respectively (BMI 22kg/m2). Body composition analysis indicated high body fat percentage (39.6%), low skeletal muscle mass (15.3kg) and body phase angle (3.6) with low SMI (4.3kg/m2) despite normal BMI. Edema is present indicated by the high ECW ratio of score 0.402 at the right and left leg. All blood profile was normal but CRP was elevated. Patient was already on established RTF for 2 months but was restarted due to hemodynamically unstable during admission, at 50cc of standard polymeric formula, 3 hourly, 7x/day (308 kcal; 12.25g/ protein).
Inadequate enteral nutrition infusion related to infusion volume not reached as evidenced by feeding history (21% energy adequacy).
To provide adequate energy (1500 kcal; 30 kcal/ABW) and protein intake (60 g; 1.2kg/ABW). RTF feeding regime was changed to fluid restriction formula in view of ROF, with full regime provides 97% energy adequacy and 1.3g protein/kg and total fluid of 854 ml/day.
Monitoring & Evaluation
During monitoring, fast AF issue had been stabilized. Patient’s feeding was tolerated and reassessment of body composition and total body water will be done for continuation of rehabilitation.
i) Skeletal Muscle Index (SMI) shows patients is having sarcopenia in which patient need high
protein to reduce the progressive of low muscle mass.
ii) Patient nutritional status and dietary factor will influence the rehabilitation outcome.