Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
Mr. Edward's blood glucose level rises to 350 mg/dL. What response from the health care team is most appropriate?

Question

Quizplus · Accepted Answer

Mr. Edward's elevated blood glucose level indicates hyperglycemia, likely caused by the high glucose content of his TPN solution. The appropriate response is to infuse insulin along with his TPN. This will help to regulate his blood glucose levels and prevent further complications. Tapering off his lipid infusion or stopping TPN entirely may not be appropriate as these are essential nutrients for his nutrition support. Increasing the dextrose concentration from 5% to 10% may worsen hyperglycemia and is not recommended.

Mr Stanley Edward, a 58-Year-Old African American Male, Was Admitted