Topical Area: Medical Nutrition
Objectives : Patients undergoing stem cell transplant (SCT) often develop malnutrition as a result of disease state, pre-transplant regimen, and graft versus host disease. SCT patients are placed on nutrition support to prevent malnutrition and thus, higher mortality and morbidity. Enteral nutrition (EN) is preferred over parenteral nutrition (PN) support as it associated with decreased infection and inflammation, preserved gut function, and fewer complications overall. However, SCT patients often experience gastrointestinal intolerance (GI) (e.g., vomiting, abdominal distension, and diarrhea) as well as psychological stress with EN.
Methods : The patient was a 64-year old female who presented with complications of acute kidney injury and dysphagia with PEG placement after SCT two months prior. She experienced consistent, persistent EN intolerance. The nutrition diagnoses were a) inadequate EN infusion related to EN intolerance as evidenced by emesis, persistent nausea, and reaching only 48% of daily goal EN volume and b) severe chronic disease related malnutrition related to decreased energy intake secondary to disease state as evidenced by energy intake < 75% of estimated energy requirements for >1 mo, unintentional weight loss >10% in 6 mo, and severe muscle mass loss in thighs, calves, shoulders, and clavicles. Nutrition interventions involved decreasing the EN rate, prescribing oral supplements, suggesting the addition of antiemetic/anti-anxiety medication, and encouraging intake by mouth per diet advancement.
Results : Although literature suggests choosing EN first for nutrition support in patients undergoing SCT, there are limited recommendations on how to effectively address GI and psychological stress that result from EN protocol. The patient was able to take in liquids/supplements by mouth and advanced to a regular diet. If she, however, would have continued to have severe EN intolerance and unable to take in nutrition by mouth, partial or total PN would have been indicated to prevent further malnutrition.
Conclusions : Although EN improves patient outcomes for SCT patients, especially those with dysphagia, there is an opportunity to enhance care by establishing situation specific protocols/guidelines to prevent or reduce complications like GI and psychological distress.
Funding Sources : NA