Nutrition Case Studies

Question 1

What is the rationale for using atracurium on ICU?

Answer 1

Paralysing agent – used to allow better synchronisation with the ventilator in patients with severe respiratory failure.

Question 2

What are the nutritional considerations for atracurium?

Answer 2

Decreases energy expenditure and gut motility

Question 3

What are the nutritional considerations for propofol 250mg/h?

Answer 3

Contributes additional energy of 1 kcal/mL Risk of fat overload

Question 4

What is the rationale for using noradrenaline on ICU?

Answer 4

Vasoconstrictor or vasopressor – used to increase blood pressure and increase heart rate by stimulating alpha receptors in walls of peripheral blood vessels to constrict and narrow

Question 5

What are the nutritional considerations for noradrenaline?

Answer 5

High doses cause a reduction of hepatic, renal and splanchnic blood flow. Can lead to enteral feeding intolerance and risk of gut ischaemia

Question 6

What is the rationale for using Insulin-VRIII on ICU?

Answer 6

To treat critical illness-associated insulin resistance and hyperglycaemia

Question 7

What are the nutritional considerations for Insulin-VRIII?

Answer 7

Caution when enteral nutrition is held to avoid hypoglycaemia

Question 8

What is the rationale for using sodium docusate on ICU?

Answer 8

Laxative used to treat constipation

Question 9

What are the nutritional considerations for sodium docusate?

Answer 9

Enteral nutrition is often considered a cause of diarrhoea. Therefore need to check that diarrhoea is not result of repeated doses of laxative

Question 10

What is the rationale for using lansoprazole on ICU?

Answer 10

Proton pump inhibitor used to inhibit gastric acid secretion. Used for stress ulcer prophylaxis in critically ill patients

Question 11

What are the nutritional lansoprazole?

Answer 11

Alters pH and can make NG tube placement confirmation by pH paper unreliable

Question 12

What is the rationale for using phenytoin IV on ICU?

Answer 12

Anticonvulsant

Question 13

What are the nutritional considerations for phenytoin IV?

Answer 13

If given via the enteral route requires a break from feed for drug

Question 14

What is the rationale for using fentanyl on ICU?

Answer 14

Opioid analgesia and sedation agent

Question 15

What are the nutritional considerations for fentanyl?

Answer 15

Can cause constipation and decrease gut motility resulting in reduced gastric emptying

Question 16

What are the nutrition goals in SBS?

Answer 16

1. Prevent dehydration • Aiming for urine sodium >20 mmol/L
   • by encouraging adherence to fluid restriction
   • and consumption of an oral rehydration solution over the next 2 wks.
2. Improve nutritional status
   • by showing an ↑ in lean body mass
   • evidenced by ↑ mid-arm muscle circumference & handgrip strength over next 4 wks.

Question 17

What is SBS?

Answer 17

< 2 metres from duodenojejunal flexure

Question 18

What are the critical lengths in SBS?

Answer 18

• < 100cm of jejunum = long term intravenous fluid + e-
• < 75 cm of jejunum = long term PN, fluid + e-
• < 50 cm of jejunum + colon = long term PN, fluid + e-