PD274 - NAVIGATING ENTERAL NUTRITION IN PROLONGED MECHANICAL VENTILATION FROM FOOD-BORNE BOTULISM: A 100-DAY CASE REPORT

PD274

NAVIGATING ENTERAL NUTRITION IN PROLONGED MECHANICAL VENTILATION FROM FOOD-BORNE BOTULISM: A 100-DAY CASE REPORT

R. A. Aldosary^1,*

¹Clinical Nutrition, King Saud Medical City, Riyadh First Health Cluster, Riyadh, Saudi Arabia

Rationale: Food-borne botulism requiring prolonged mechanical ventilation (MV) presents three major nutritional crises: refeeding syndrome, gastrointestinal intolerance with feeding refusal, and discharge-delaying bulbar paralysis. Currently, no disease-specific nutritional protocol exists, and fewer than 50 cases are documented in the literature.

Methods: Retrospective case report of a 22-year-old Saudi female admitted following ingestion of contaminated mayonnaise, documented across 100 hospital days (April–August 2024).Dysphagia assessed using MBSS and FOIS

Results: The patient required 53 days of MV. Enteral nutrition was initiated on Day 3 following hypophosphatemia (0.59 mmol/L); thiamine and multivitamins were prescribed prophylactically. Full caloric target (1,600 kcal/day) was reached Day 9; protein escalated to 99 g/day by Day 19. Recurrent electrolyte derangements, hypophosphatemia (nadir 0.38 mmol/L), hypokalaemia (panic value 1.2 mmol/L), and hypomagnesemia (nadir 0.50 mmol/L) required serial corrections. Five formula transitions addressed gastrointestinal intolerance; repeated NGT refusal by a cognitively intact but severely distressed patient introduced a psychosocial dimension rarely documented. Albumin declined to 25 g/L despite adequate delivery. Three serial modified barium swallow studies confirmed non-linear bulbar recovery; functional swallowing was established only at Day 101. The patient was discharged Day 102, GCS 15/15, tolerating a soft diet

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Conclusion: This case illuminates a defining paradox: gastric motility recovers earlier than bulbar function, rendering swallowing paralysis not gastrointestinal tolerance the ultimate barrier to discharge. RS prophylaxis, formula optimization, and compassionate management of patient-driven refusal are indispensable. Serial dysphagia surveillance defines the safe oral transition threshold.

Disclosure of Interest: None declared