An 84-year-old man is being treated for advanced pharyngeal cancer with radiation and chemotherapy. He complains of mouth ulcers, pain, and difficulty swallowing. His other medical problems include hypertension, osteoporosis, and Parkinson's disease. He had a stroke several years ago. His older son lives with him, and helps with his care. The patient weighs 132 pounds (60 kg), and his BMI is 22 kg/m². His lab values are as follows: Gastrostomy tube is placed for enteral feeding. Which of the following is the most appropriate nutrition goal for this patient?

Question

Quizplus · Accepted Answer

Explanation: This patient's BMI is currently at an acceptable level and other than mild anemia there are no significant laboratory abnormalities at this time. However, this patient has a number of obstacles in maintaining adequate intake by mouth including his pharyngeal cancer, prior stroke, Parkinson's disease, and mucosal ulcers likely secondary to chemoradiation. In general, if the gastrointestinal tract is able to function such as in this patient, then enteral feedings are preferred to parenteral feeds. Enteral feeds are more physiologic and in general have fewer complications. A gastrostomy tube can either be placed surgically or percutaneously by endoscopy or interventional radiology. The standard caloric intake recommended for enteral feeding is 30 kcal/kg/day, with a lower amount used for patients with severe preexisting malnutrition in order to prevent refeeding syndrome. A 1g/kg level of protein is appropriate for most patients. (Choice A) A lower calorie enteral feed could be considered for patients with severe malnutrition in order to prevent refeeding syndrome. (Choice C) Enteral feeds with calories above the standard 30kcal/kg/day are usually unnecessary. (Choice D) A low calorie level with elevated protein could be considered for patients with malnutrition, but this patient's baseline nutrition is satisfactory. Educational objective: Enteral feeding is preferred to parenteral feedings for patients who have a functioning gastrointestinal system. The standard composition of 30 kcal/kg/day and 1 g/kg/day of protein is satisfactory for most patients with adequate baseline nutrition.

An 84-Year-Old Man Is Being Treated for Advanced Pharyngeal Cancer