Risks and complications of malnutrition persist despite optimal nutritonal intake in a patient with pancreatic cancer

Abstract

Learning outcomeTo increase the awareness among staff physicians that achieving optimal nutrition outcomes is not limited to the administration of estimated calories and protein.TextThis case report illustrates that malnutrition may persist despite provision of >160% estimated needs. A 78-year old male was admitted to our subacute unit following a Whipple procedure for pancreatic cancer. Admit weight=174 lbs. (UBW=190 - 200 lbs.). Admitted on amino acid-based tube feeding (TF) formula (via J-tube) providing 1870 kcals; 93 g protein. Food aversions limited oral intake to pleasure foods only. Weight decreased to 156 lbs and continued to decline despite increase to 3000 kcals; 150 g protein. Although calculated nutritional requirements were provided for several months, patient appeared malnourished. On assessment, labs confirmed depleted visceral proteins: albumin=2.7 g/dL (norm=3.5 - 5.0 g/dL); prealbumin=10.2 g/dL (norm=20 - 40 g/dL). TF formula switched to high-calorie, peptide-based, elemental diet to facilitate protein absorption and utilization (2,160 kcals; 97 g protein). Oral intake increased; pancreatic enzyme therapy initiated. Weight increased to 171 lbs., prealbumin increased to 14.1 g/dL. TF discontinued, pancreatic enzyme continued, based on physician assessment that oral intake was adequate. Albumin and prealbumin plummeted to 1.8 g/dL and 6.3 g/dL, respectively. Peptide-based TF reinitiated at 1,350 kcals; 60 g protein to augment oral intake. Albumin and prealbumin began to rise; weight remained stable. Shortly thereafter, patient was discharged home consuming the high-calorie, peptide-based formula with flavoring. For this patient, the desired nutritional outcomes were not achieved simply by meeting estimated caloric goals, but only when the nutritional regimen and formulation was uniquely suited to meet metabolic and physiologic needs.FUNDING DISCLOSURE: Learning outcomeTo increase the awareness among staff physicians that achieving optimal nutrition outcomes is not limited to the administration of estimated calories and protein. To increase the awareness among staff physicians that achieving optimal nutrition outcomes is not limited to the administration of estimated calories and protein. TextThis case report illustrates that malnutrition may persist despite provision of >160% estimated needs. A 78-year old male was admitted to our subacute unit following a Whipple procedure for pancreatic cancer. Admit weight=174 lbs. (UBW=190 - 200 lbs.). Admitted on amino acid-based tube feeding (TF) formula (via J-tube) providing 1870 kcals; 93 g protein. Food aversions limited oral intake to pleasure foods only. Weight decreased to 156 lbs and continued to decline despite increase to 3000 kcals; 150 g protein. Although calculated nutritional requirements were provided for several months, patient appeared malnourished. On assessment, labs confirmed depleted visceral proteins: albumin=2.7 g/dL (norm=3.5 - 5.0 g/dL); prealbumin=10.2 g/dL (norm=20 - 40 g/dL). TF formula switched to high-calorie, peptide-based, elemental diet to facilitate protein absorption and utilization (2,160 kcals; 97 g protein). Oral intake increased; pancreatic enzyme therapy initiated. Weight increased to 171 lbs., prealbumin increased to 14.1 g/dL. TF discontinued, pancreatic enzyme continued, based on physician assessment that oral intake was adequate. Albumin and prealbumin plummeted to 1.8 g/dL and 6.3 g/dL, respectively. Peptide-based TF reinitiated at 1,350 kcals; 60 g protein to augment oral intake. Albumin and prealbumin began to rise; weight remained stable. Shortly thereafter, patient was discharged home consuming the high-calorie, peptide-based formula with flavoring. For this patient, the desired nutritional outcomes were not achieved simply by meeting estimated caloric goals, but only when the nutritional regimen and formulation was uniquely suited to meet metabolic and physiologic needs.FUNDING DISCLOSURE: This case report illustrates that malnutrition may persist despite provision of >160% estimated needs. A 78-year old male was admitted to our subacute unit following a Whipple procedure for pancreatic cancer. Admit weight=174 lbs. (UBW=190 - 200 lbs.). Admitted on amino acid-based tube feeding (TF) formula (via J-tube) providing 1870 kcals; 93 g protein. Food aversions limited oral intake to pleasure foods only. Weight decreased to 156 lbs and continued to decline despite increase to 3000 kcals; 150 g protein. Although calculated nutritional requirements were provided for several months, patient appeared malnourished. On assessment, labs confirmed depleted visceral proteins: albumin=2.7 g/dL (norm=3.5 - 5.0 g/dL); prealbumin=10.2 g/dL (norm=20 - 40 g/dL). TF formula switched to high-calorie, peptide-based, elemental diet to facilitate protein absorption and utilization (2,160 kcals; 97 g protein). Oral intake increased; pancreatic enzyme therapy initiated. Weight increased to 171 lbs., prealbumin increased to 14.1 g/dL. TF discontinued, pancreatic enzyme continued, based on physician assessment that oral intake was adequate. Albumin and prealbumin plummeted to 1.8 g/dL and 6.3 g/dL, respectively. Peptide-based TF reinitiated at 1,350 kcals; 60 g protein to augment oral intake. Albumin and prealbumin began to rise; weight remained stable. Shortly thereafter, patient was discharged home consuming the high-calorie, peptide-based formula with flavoring. For this patient, the desired nutritional outcomes were not achieved simply by meeting estimated caloric goals, but only when the nutritional regimen and formulation was uniquely suited to meet metabolic and physiologic needs. FUNDING DISCLOSURE: