Frank is a 52-year-old male who began to feel unwell 4 months ago. His appetite declined, and he could not taste food as well as he used to. When he lost a considerable amount of weight and became weak as a result, he visited his doctor

Question

The examination revealed Frank had adenocarcinoma of the pancreas, and surgery was immediately ordered. During his hospitalization, Fred was slow to gain weight and his muscles were wasted. In order to build up his strength for chemotherapy, his wife tried to tempt him with freshly baked cookies and sweets she brought from home.

In severe protein-calorie malnutrition, what is a potential complication of rapid enteral refeeding? What effects does protein-calorie malnutrition have on the gastrointestinal system?

What might Frank's nitrogen balance be? Why would he have this type of nitrogen balance?

Frank's nurses encourage him to eat the potatoes and dinner rolls that come with his meals. Why are they encouraging Frank to complete the carbohydrates on his plate?

Answer 1

Enteral feeding, particularly in the very malnourished individual, can result in symptoms associated with malabsorption. In protein-calorie malnutrition, there is atrophy of the gastrointestinal mucosal layer. Intestinal villi are also lost. Enteral refeeding can therefore produce malabsorptive symptoms if the intestinal mucosa is unable to process ingested nutrients.

Frank is likely to be in negative nitrogen balance. Protein is the only source of nitrogen for the body. When protein intake matches nitrogen excretion, an individual is in nitrogen balance. In situations where there is tissue breakdown from illness or decrease in dietary protein, nitrogen loss exceeds intake. Frank's pancreatic cancer and loss of appetite would result in tissue catabolism, creating a state of negative nitrogen balance.

Carbohydrates in the diet ensure energy requirements are met without converting proteins or fats to usable energy sources. Ketone production has the effect of decreasing appetite, an undesirable effect in those who are ill or underweight. Protein and fat metabolism also generates metabolic wastes that are osmotically active. Renal excretion of these wastes can lead to dehydration and electrolyte imbalances. A diet containing carbohydrates is therefore necessary to prevent the catabolism of tissue proteins and the production of ketone bodies.