PD1072 - CASE REPORT: WHEN OUR EQUATIONS ARE JUST NOT ENOUGH

PD1072

CASE REPORT: WHEN OUR EQUATIONS ARE JUST NOT ENOUGH

M. Sheahan-McElvaney^1,*, E. Andrews²

¹Dept of Nutrition and Dietetics, ²Dept of Surgery, Cork University Hospital, Cork, Ireland

 

Rationale: Predictive equations are standard for estimating perioperative energy needs,but Indirect Calorimetry (IC) remains the gold standard for accuracy. This case demonstrates how equations can fail to match true metabolic requirements,necessitating IC in clinical practice.

Methods: A 27 yr old male was admitted under the care of the colorectal team with a subacute mechanical small bowel obstruction due to a Crohns stricture. His medical history included Crohns Disease.He previously had a panproctocolectomy, ileal pouch - anal anastomosis.  Following optimisation, he proceeded to have an open small bowel resection with ileostomy formation. On admission , his weight was 47kg, height 1.57m.

The nutritional aim at the time of referral was preoperative optimisation. Nutritional support transitioned from preoperative PN to postoperative supplemental PN, then to a full oral diet with supplements. He had a known allergy to egg, fish,nuts and kiwi.

Results: Initial targets used Schofield (1,821 kcal/d with stress/activity factors) and 25–30 kcal/kg (1,175–1,410 kcal/d). During the first 2 weeks of treatment, the patient’s weight fluctuated from 47.1kg to 48.75 kg Despite receiving 38 kcal/kg by week 3, the patient’s weight dropped to 46.1kg, prompting IC.

 

Date	IC (inc PAL 1.4) kcal/d	Kcal /Kg	Weight (Kg)
9.10	2063	44.7	46.1
16.10	2161	44.56	48.5
07.11(Post-Op)	2699	55.7	48.4

Table1. Requirements and Weight. The respiratory quotient remained within range at each measurement.

 

Pre -operative requirements as determined by IC exceeded both equations by 18.6% and 53.2% respectively. Post-op, again IC exceeded that calculated by equations by  46% and 85.8%.

Conclusion: IC-determined requirements vastly exceeded predictive formulas throughout the perioperative journey. Using IC enabled an otherwise unattainable improvement in patient outcomes.This data supports the need for personalized nutrition and adequate staffing to integrate IC as a standard care component for colorectal patients.

Disclosure of Interest: None declared