Neuro & Plastics

Dear All,

This week I have been performing my rotation in Neuro/Plastics. I find these patients particularly interesting because they present with nutrition-related issues we do not commonly see in other rotations. Here are a few of the my thoughts/examples:
1. I have seen two burn patients this week. These patients are unique because they require high calorie, high protein diets along with 3 snacks per day. Thus, they can eat almost anything they so desire. In estimating the needs for these patients, we use the Harris-Benedict Equation (which I have not used up to this point). The following Standards of Care are used at WFUBMC:
BEE x 1.1 (<20% TBSA burns)
BEE x 1.2 (20-30% TBSA burns)
BEE x 1.3 (30-40% TBSA burns)
BEE x 1.4 (>40% TBSA burns)
For estimating protein needs, we use:
Use IBW or, for obese patients, ABW-
1.5-1.8 gm pro/kg IBW (<20% TBSA)
2.0-2.5 gm pro/kg IBW (>20% TBSA)

Just thought you might find those recommendations helpful or in the near future.

2. I also saw a patient today diagnosed with dysphagia who had a seizure disorder, dementia, and psychosis. Based on the speech therapist's recommendation, the patient should be placed on a Dysphagia Pureed Diet, No Liquids. Furthermore, because of the nature of the diagnoses, the speech therapist indicated that the patient may not improve from his/her current state (ie- may never advance from this diet). Thus, the role of the dietitian is to recommend that the patient receive a permanent NG tube or PEG to satisfy his hydration needs because he/she cannot consume liquids. Just an interesting case. The recommendation for the enternal tube placement had initially slipped my mind amidst the busyness of charting, so thought I would share it...

Hope all of you are having a great week!
Rachael