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Megan Fobar - Case Study Abstract

This case study abstract describes the complex nutrition support needs of a 15-year-old patient admitted to the ICU after suffering a left MCA stroke with hemorrhagic conversion. The patient presented at 471 pounds upon admission. Nutrition support has been challenging due to the patient's age, body habitus, critical condition, ventilator dependence, and other factors affecting metabolism. Post-pyloric tube feeds have been used and frequently adjusted based on needs and complications like hyperphosphatemia and GI bleeding. The patient's status has gradually improved over two months in the hospital and he has been transferred from the ICU to continue rehabilitation.

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143 views

Megan Fobar - Case Study Abstract

This case study abstract describes the complex nutrition support needs of a 15-year-old patient admitted to the ICU after suffering a left MCA stroke with hemorrhagic conversion. The patient presented at 471 pounds upon admission. Nutrition support has been challenging due to the patient's age, body habitus, critical condition, ventilator dependence, and other factors affecting metabolism. Post-pyloric tube feeds have been used and frequently adjusted based on needs and complications like hyperphosphatemia and GI bleeding. The patient's status has gradually improved over two months in the hospital and he has been transferred from the ICU to continue rehabilitation.

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api-288109471
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© © All Rights Reserved
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Megan Fobar

Dietetic Intern

Case Study Abstract: Nutrition Support in Neurocritical Care


A 15 year old patient, assessed at 60 inches and 471 pounds upon admit, presented to the
UCSD Medical Center after suffering a left-sided middle cerebral artery (MCA) stroke with
hemorrhagic conversion. A hemicraniectomy was immediately performed and the patient was
admitted to the Critical Care Unit. Nutrition support for this patient was complex due to his age,
body habitus, and critical condition. The approach to estimating and meeting the nutrition needs
of a 15 year old neuro critical care patient must account for a number of factors, including
ventilator dependence, intracranial pressure, propofol administration, increased sodium goals,
and the use of pressors. Since research related to the use of predictive equations in this
population is limited, the metabolic monitor was used to verify the estimated needs. Post-pyloric
tube feeds have been used to provide nutrition support, with frequent adjustments to the formula
and infusion rate based upon current needs and other factors. Additional events that have
affected nutrition support for this patient include hyperphosphatemia, periods of increased stool
output, a high-risk PEG placement, and a gastrointestinal bleed. This patients status has
gradually improved over his two-month hospitalization and he was recently transferred out of the
intensive care unit. Nutrition support continues to be an important factor for strengthening his
rehabilitation potential as he begins to work more intensively with physical, occupational, and
speech therapy.

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