Parenteral Nutrition Case Study - Crohn's Disease

Join Lauren MS, RD, CNSC as she shares a Crohn's disease case study complicated by an enterocutaneous fistula and a struggle to achieve patient weight stabilization and gain. After reviewing the progressive parenteral nutrition recommendations, Lauren discusses micronutrient repletion strategies to combat deficiencies following prolonged PN use in this case patient.
Disclaimer: Information from this case study is for educational purposes only and should not be used directly to prescribe or provide care to patients.
Closed Captions provided by Kaitlyn Batista MS, RDN, CDN, CNSC
Timestamps:
0:23 Mr. M Case Study Overview
0:43 Brief pathophysiology of stricutring Chron’s disease
1:32 Case study background
2:29 Anthropometrics
3:17 Mr M’s hospital course, TPN orders, and calculations
11:39 Micronutrients in long-term PN patients
15:41 Summary
Looking for more information about Enterocutaneous Fistulas? Check out this helpful video!
• Enterocutaneous Fistul...

[@ellieuki1504]

Curious to why run a Vitamin A test? Is this common? I was under the impression that given the body stores vit A in the liver which inhibits the serum level from effectively reflecting a vit A deficiency?

[@DietitiansinNutritionSupport]

Thank you so much for your question. Per ASPEN Adult Nutrition Support Core Curriculum (2017), evaluating Vitamin A stores annually on a patient requiring long term TPN is appropriate. Vitamin A status should be measured by serum retinol and keep in mind that measuring CRP and retinol binding protein can also support lab value interpretation as increased inflammation can decrease serum/plasma retinol concentrations.

[@Anima7e]

How often were you increasing? Weekly weight?

[@DietitiansinNutritionSupport]

Thank you for your question! For this patient, the macronutrient increases happened over the course of several months, however the patient was weighing himself at least weekly.