Question

A 65 year old female had complications associated with GI surgery, and was admitted to the intensive care unit with pneumonia and septic shock. After she became hemodynamically stable, she was started on parenteral nutrition secondary to a prolonged ileus. Prior to surgery, she was at her ideal weight. Currently her labs include albumin 2.0 mg/dL and creatinine 1.0 mg/dL. Her urine output is adequate. Which of the following best estimates her protein needs for initiation of parenteral nutrition therapy?

1: 0.6 grams/kg
2: 0.8 grams/kg
3: 1.5 grams/kg
4: 2.5 grams/kg

Answer 1

The protein needed for initiating parenteral nutrition therapy in the described patient would most likely be 1.5 grams/kg, considering her clinical situation, including her malnutrition signified by low albumin levels.

Step-by-step explanation:

The best estimate for initiating parenteral nutrition therapy in a 65-year-old female with post-surgical complications, pneumonia, and septic shock would be 1.5 grams/kg based on her clinical condition and current lab values. Her low albumin may indicate malnutrition, which is not uncommon after such a post-operative complication along with an ileus. The creatinine level seems to be within the normal range, signifying likely adequate renal function.

Patients with acute illnesses or who are undergoing major surgeries and are in critical care often have increased protein requirements to help with healing, immune function, and recovery which supports the 1.5 grams/kg estimation. Unlike in cases with significant renal impairment, where protein should be restricted, her adequate urine output and normal creatinine level indicate that her kidneys can likely tolerate this amount of protein. Therefore, an aggressive nutrition therapy approach is appropriate for her recovery.

The administration of such nutrition therapy should be monitored closely with frequent reassessments of her protein needs, as her condition may change rapidly, requiring adjustments in the nutritional regimen.