PD289 - COMBINED ENTERAL AND PARENTERAL NUTRITION WITH TARGETED AMINO ACID SUPPLEMENTATION IN A CRITICALLY INJURED COMBATANT WITH SEVERE FEEDING INTOLERANCE: A CASE REPORT

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PD289

COMBINED ENTERAL AND PARENTERAL NUTRITION WITH TARGETED AMINO ACID SUPPLEMENTATION IN A CRITICALLY INJURED COMBATANT WITH SEVERE FEEDING INTOLERANCE: A CASE REPORT

V. Lokhno1, R. Zatsarynnyi1, O. Khomenko2,*, Y. Stadnik1

1Anesthesiology and Intensive Care, National Scientific Center of Surgery and Transplantation, 2Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, Kyiv, Ukraine

 

Rationale: The issues of severe polytrauma consists of extreme metabolic stress, that switches the organism to catabolic state. It becomes a challenge to maintain adequate daily protein dose without caloric overload using standard combination of enteral (EN) and parenteral nutrition (PN) [1].

Methods: 29-years old combatant with mine-blast trauma: bilateral lower limb amputation (level of thigh joint), left upper limb amputation, eye loss, orchiectomy and urethral injury. Patient was mechanical ventilated via tracheostoma for one month, had acute kidney injury (AKI) with continuous veno-venosus hemodiafiltration and intermittent hemodialysis daily for 32 days. Hypoproteinemia was diagnosed. It was a challenge to deliver calories and protein targets because of three limbs loss and EN intolerance.  We decided to use adjusted body weight – 50 kg for calculation the needs [2]. Targets were:  25-27 kcal/kg/day and protein - 1,5-1,7 g/kg/day. We used EN with protein content 19,5 g/100 ml and PN - with 14,2 g/100 ml. PN volume was limited because of risks of caloric overload. We added amino acid solution as described in Tab.1 to deliver the targets. 

Results: Tab 1. EN, PN and Amino acid combination to achieve calories and protein targets in injured combatant.

Nutrition

EN

PN

Amino acid solution

Total

kcal

880

(15 kcal/kg)

580

(10 kcal/kg)

144

(2 kcal/kg)

27 kcal/kg/day

protein

32

(0.5 g/kg)

32

(0.5 g/kg)

36

(0.6 g/kg)

1,6

g/kg/day

After adding amino acids solution we achieved protein target 1.6 g/kg/day without caloric overload.

Patient was treated in the ICU for 60 days and had 110 days in total of hospital stay.

 

Conclusion: Amino acids supplement is an effective way to reach protein target without caloric overload in  severe trauma patient in catabolic state with EN intolerance.

References: [1] https://doi.org/10.1016/j.clnu.2023.07.011.

[2] https://doi.org/10.1016/S0002-8223(95)00050-X.

Disclosure of Interest: None declared