Outline the nutrition support regimen you would recommend for Mr. McKinley. This should include formula choice (and rationale) and rate initiation and advancement

Question

What will be an ideal response?

Answer 1

20 mL/hour of Peptamen Bariatric and increase as tolerated by 10-20 mL every 8-12 hours until goal rate of 80 mL/hour (based on 22 hours per day for an ICU patient) is reached. This will provide 1760 mL total volume, 1760 total kcalories, 164 g protein, and 1478 mL free water. Provide approximately 5 flushes of 60 mL free sterile water throughout the day (every ~4 hours).
This formula is chosen for Mr. McKinley because it has a high protein-to-calorie ratio and can help meet the protein requirement for the critically ill obese population. It is also a hydrolyzed formula, which may assist in optimal absorption. It has a lipid profile to support modulation of proinflammatory mediators in the critically ill, along with carbohydrate levels to support the nutrition management of blood glucose levels for those with diabetes or under metabolic stress. A continuous feed would be best for Mr. McKinley because a continuous feed with a slower advancement will be better tolerated with his bowel reconstruction and allow for a more stabilized blood glucose.