Patient: 40 y.o. WM Dx: mandibular fracture, multiple facial fractures PMH: pt denied any PMH PSH: pt denied any PSH MEDS: ◦ cefazolin - surgical prophylaxis ◦ dexamethasone ◦ Heparin ◦ morphine (PRN) Anthropometrics: ◦ Ht: 5’11” (180cm) ◦ Wt: 165lbs (75kg) ◦ IBW: 172 (78.2kg) ◦ %IBW: 96% ◦ BMI: (normal) Labs: All pertinent labs are normal.
Diet order: clear liquid diet for entire stay Meal consumption: 100% for entire stay PES STATEMENT: Biting/chewing difficulty related to mandibular fracture as evidenced by wired jaw and the need for a liquid diet. Nutrition Interventions: 1. Ensure Plus vanilla or chocolate tid (low residue and allowed on clear liquid diet). 2. Brief education discussed with patient, wired jaw/fracture diet, how to liquefy food, and food supplement information.
SourceKcal requirementsProtein requirementsFluid requirements Union Memorial Hospital standard s Based on % IBW = kcal/kg = Based on unstressed, well nourished clinical condition = g/kg = Based on % IBW = kcal/kg = EALNo standard requirements for healthy adults. No evidence for a clinical or biochemical measure that best assesses hydration status ( grade III evidence). There are also no validated or established equations for determining fluid needs ( grade V evidence). NCMPatient not intubated, use Mifflin-St. Jeor (x1.2) = 2018 kcals/day From DRI and US Dietary Guidelines 2010 = 10-35% of energy intake = g Recommended Dietary Allowance = 1 mL/kcal of intake = mL fluid required daily = 2018 ml
% IBWWeight range Loss from current weight % Loss in 1 month 80-90% IBW, mild malnutrition kg kg %, severe 70-79% IBW, moderate malnutrition kg kg %, severe < 69% IBW, severe malnutrition < 54 kg21 kg28%, severe Study by Manus, et al Study by Guo, et al
Homeless Substance abuse Poor family relations No source of income Compliance to nutritional care Compliance to medical care
Manzcs, R., Jr, DMD, Dodson, K., DMD, MPH, Miller, E., Jr, DMD, and Perciaccante, V., DDSJ Nutritional Status of Substance Abusers With Mandible Fractures. Journal of Oral Maxillofacial Surgery, 58: Guo, C., Ma, D., Zhang, K., Hu, X Relation between nutritional state and postoperative complications in patients with oral and maxillofacial malignancy. British Journal of Oral Maxillofacial Surgery, 45: 467–470. American Dietetic Association Nutrition Care Manual. REE/EEE Calculator Equations, Ireton-Jones (IJEE) 1992 Equation. highlight=mifflin%20st%20jeor highlight=mifflin%20st%20jeor American Dietetic Association Evidence Analysis Library Citations. What is the best equation to estimate fluid requirements in adults 19 years and older? = =250894