Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center upon being found unconscious in his car in a parking lot and resuscitated. His history was obtained by contacting his daughter. The patient presents with:

Question

• end-stage adenocarcinoma of the gastroestophageal 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. Plan is to keep Mr. Edward NPO and place a peripheral line for hydration and nutrition support.
To avoid liver impairment associated with parenteral feeding, the nutrition support team will need to avoid which of the following when calculating Mr. Edward's PPN orders?

a. giving the patient excess energy
b. giving the patient excess dextrose
c. giving the patient excess lipids
d. all of the above

Answer 1

d