Case In A Minute - Results

CASE 3 — SAIO: WHEN DO YOU SAY “START PN”?

A 67-year-old man with three previous abdominal surgeries is admitted with recurrent subacute intestinal obstruction (SAIO).

CT shows:

  • Dilated small-bowel loops
  • Transition point in distal ileum
  • No bowel ischemia
  • No perforation
  • No collection

He is being managed conservatively with NG decompression.

Nutrition assessment:

  • BMI: 18.6 kg/m²
  • Unintentional weight loss: 9% in 3 months
  • Minimal oral intake for 7 days
  • Currently NPO
  • Marked muscle wasting
  • CRP: 42 mg/L

By day 5, the obstruction has not completely resolved.

NG output remains significant.

The surgical team expects that oral/enteral feeding may not be possible for several more days, although surgery is not currently planned.

What is the MOST appropriate nutrition strategy?

D. Initiate PN because of his high nutritional risk and anticipated continued inability to meet requirements enterally, while reassessing daily for restoration of GI function.
88.10%
C. Start very-low-rate gastric EN because even minimal feeding is preferable to PN in an obstructed patient.
9.52%
B. Wait until day 7–10 before considering PN because a period of starvation is generally acceptable if hydration is maintained.
2.38%
A. Continue NPO with IV fluids and wait for resolution of the obstruction before introducing nutrition.
0.00%

42 votes