A 72-year-old ICU patient on enteral feeding develops diarrhe
Answer: C
Explanation: Diarrhea in enteral nutrition often improves by adjusting rate and formula before medications.
Teaching Points: - Evaluate formula composition and feeding speed first.
The most accurate method to assess resting energy expenditure in critically ill patients is:
Answer: C
Explanation: Indirect calorimetry measures oxygen consumption and CO2 production to calculate energy needs accurately.
Teaching Points: - Predictive equations may under/overestimate energy needs in ICU patients.
A 65-year-old postoperative patient is receiving Total Parenteral Nutrition (TPN). On the 5th day, he develops jaundice and elevated liver enzymes. Which complication is most likely?
Answer: C
Explanation: Long-term TPN without enteral stimulation leads to reduced bile flow, causing cholestasis and hepatic dysfunction.
Teaching Points: - Enteral feeding maintains gut and biliary tract motility.
- Early minimal enteral feeding reduces TPN
- associated liver dysfunction.
A 48-year-old male with chronic alcoholism and severe malnutrition is started on enteral nutrition after being NPO for several days. Within 48 hours, he develops confusion, muscle weakness, and arrhythmias. Laboratory investigations reveal low phosphate levels. What is the most likely diagnosis?
Answer: B
Explanation: Refeeding syndrome occurs when nutrition is reintroduced to a severely malnourished patient, leading to a sudden shift of electrolytes (especially phosphate, potassium, and magnesium) into cells. The rapid increase in insulin secretion after feeding drives phosphate intracellularly, causing hypophosphatemia. Low phosphate leads to impaired ATP production, resulting in muscle weakness, respiratory failure, arrhythmias, seizures, and neurologic disturbances. Early recognition and gradual refeeding with close electrolyte monitoring are essential.
Teaching Points: - Refeeding syndrome is caused by insulin
- driven intracellular shift of electrolytes after reintroduction of calories.
- Hypophosphatemia is the hallmark biochemical finding.
- Start feeding slowly in malnourished patients and monitor phosphate, magnesium, and potassium closely.
- Supplement thiamine before initiating feeds in alcoholic patients.