Problem
NT is a 14-year-old Asian male with acute lymphoblastic leukemia (ALL). Both of his parents are immigrants from Korea and their family enjoys cooking traditional Korean food in their home. He has been admitted to the PICU with concerns for septic shock following chemotherapy treatment. The chemotherapy treatment occurred 8 days prior on the oncology floor. Oral intake has significantly declined over the past 8 days due to worsening mucositis, with no intake other than water and saltines over the past 3 days. NT reports vomiting and diarrhea over the past 48 hours. After admission to the PICU, he was initiated on two vasoactive agents given the hemodynamic instability. Patient is currently febrile and hypotensive.
A. Patient Chart
a) Name: NT
b) Sex: Male
c) Ethnicity: Asian
B. Hospital Admission Anthropometrics:
a) Height: 5'6"
b) PICU Admission Weight: 39.1 kg
c) BMI: 13.9
d) BMI-for-age: < 1st percentile
C. Current Diet Orders
a) NPO
Task
A. What is this child's ideal body weight?
B. Write one PES statement for this case study.
C. This child will be put on TPN to meet 100% of the nutritional needs. Assuming indirect calorimetry is not available, calculate estimated energy requirements and estimated protein intake per ASPEN guidelines.
D. Would you consider the use of a stress factor with the EER of this patient? Why or why not.
E. How would you manage advancement of TPN support if the patient is at risk for refeeding syndrome and what monitoring aspects would you closely follow?
F. Given the clinical presentation, what micronutrients might this patient be deficient in?
G. What will be your nutrition monitoring plan for this patient?
H. After 1 week in the PICU, NT has reached an oral feeding volume of 75% of energy needs and is ready to be weaned off of TPN. The family would like to resume cooking and consuming their traditional foods, including glass noodles, bulgogi, rice, and vegetables. They want to be sure to avoid any gastrointestinal distress for NT, though. Give an example of a 1-day menu for NT that would minimize GI distress but adhere to the family's cultural preferences. Provide reasoning for your choices.