Georgetown Week 12!

Clinicals are coming to an end, and I am more than ready for a break!

I'm doing staff relief as well this week, covering the medicine floor and some of the MICU (which I requested).

I had an interesting pt yesterday - he was intubated, on propofol, HD, and had an elevated Phos, with K on the lower end. I had to think for a minute before choosing the most appropriate TF formula and rate. My first thought was to choose Promote because it's low in fat, but then I noted the high Phos and wanted to go with Nepro at a lower rate to account for the propofol. But then I noted the pt was on HD, so his energy and protein needs were especially elevated, but protein needs could not be met with a low rate of Nepro. Also, with the Nepro at even a low rate goal + propofol, the pt would end up with 67% kcals from fat! But the phos in Nepro was significantly lower than Promote, and Nepro is much more concentrated so less fluid is ideal for HD. I was a bit worried about the K going lower with a low electrolyte formula, but we could just trend it. Although I did think about still going with the promote and adding a phos binder. In the end I chose Nepro. With propofol I recommended a lower rate + beneprotein, and when propofol is d/c'ed I recommended to increase the rate with no Beneprotein. I learned that high phos trumps too many kcals from fat, especially since it'll will only be temporary, as propofol isn't used LT. And it's best to avoid phos-binders if we can manage the phos through the TF.

See everyone soon!