Nutrition Therapy Case Study

INTRODUCTION

Nutrition therapy is usually placed in a lower priority compared with hemodynamic or ventilatory support in managing critically ill patients. Under- or over-feeding is not uncommon, but is under-recognized in the intensive care unit. It has been suggested that underfeeding is associated with poor wound healing and immunologic comprise. On the other hand, over-nutrition can cause fatty liver and pulmonary compromise. These complications can possibly translate into morbidities and mortalities. Appropriate nutrition therapy depends on accurate determination of energy expenditure. Critically ill patients may have altered metabolism due to their diseases and the use of multiple medications, causing great difficulties in estimating their energy expenditures. Indirect calorimetry is

Harris-Benedict equation:

Basal energy expenditure (male) = 66.5 + 13.75 × weight + 5.0 × height – 6.78 × age
Basal energy expenditure (female) = 655 + 9.56 × weight + 1.85 × height – 4.68 × age
(Weight in kilograms, height in centimeters, age in years)

Harris-benedict equation was originally published in 1919. It takes into account gender, age, height and weight. The basal energy expenditure has to be adjusted for activity and injury level. In this study for septic, critically ill patients, an activity factor of 1.2 (confined to bed) and injury factor of 1.6 (sepsis) were used to obtain the resting energy expenditure.

2. Ireton-Jones 1992 equation

Resting energy expenditure = 1,925 – (10 × age) + (5 × weight) + (281 if male) + (292 if trauma present) + (851 if burns present)
(Age in years, weight in kilograms)

The Ireton-Jones equation was first developed in 1992. Gender, age, and weight are included in the equation. It also considered the effect trauma and burn. This equation was reviewed in 1997 with a new equation created. However, validation studies later suggested the use of the 1992 equation as it is unbiased and more accurate across all critically ill