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.
Mr. Edward's blood glucose level rises to 350 mg/dL. What will the health care team likely do about this?

a. nothing; this is acceptable for a patient receiving TPN
b. taper off his lipids infusion
c. stop his TPN infusion entirely
d. infuse insulin with his TPN

Answer 1

d