History of present illness
Patient X is a man, 59 years of age, who
was admitted to the emergency department
after a motor vehicle accident. He incurred
massive head and neck injuries and was
transported to the emergency department
unconscious and hypotensive upon arrival.
He was receiving 50% O2 via oxygen mask.
His respiratory rate was 22 breaths per
minute, and lung sounds were clear
bilaterally. He had a sinus tachycardia with
a heart rate of 110 beats per minute. His
blood pressure was 90/60 mm Hg. The
patient had a 20 pack-year history of
cigarette smoking and had been taking
medications to control hypertension.
He was transported via stretcher to
radiology for a computed tomography scan,
which revealed bleeding in the peritoneum.
He was taken immediately to surgery.
Following surgery, He was taken to the ICU
and managed carefully.
Rationale for feeding the critically ill
patient
• Provision of nutritional substrates to meet
protein and energy requirement
• Protect vital organs and reduce
breakdown of skeletal muscles
• Provide nutrients for repair and healing
• Maintenance of gut barrier function
• Modulation of stress response
Indications for Enteral nutrition
 Patients with functioning GIT but
cannot feed themselves adequately
 Patients with little or no appetite for
extended periods especially the
malnourished
 Patients in coma
 Patients on mechanical ventilators
 If oral dietary intake remains
compromised or is contraindicated
for more than 5-7 days artificial
nutritional support in the form of the
enteral tube feeding may be
necessary.
Food selection for Blenderized
Formulas include:
a.Vegetables: low cellulose or succulent
vegetables (ex. Squash, carrots, chayote)
b.Fruits: all fruits without skin and seeds
c. Milk: all type
d. Rice and equivalents: lugaw, oatmeal,
sliced bread, pandesal; potato
e. Meat/poulty/fish: low fat meat (lean beef,
chicken breast, fish fillet, chicken egg)
f. Fat: vegetable
Case data:
 Age/sex: 59 y/o male
 Weight: 58 kg
 Height: 5 ft. and 7 inches (173.736 cm)
 Activity level: very light (1.3)
 Stress factor: 1.5
Diet Plan for computation
■ Body Mass Index
BMI = Weight in kg / Height in m2
BMI = 58kg/ (2.99m^2)
BMI = 19.39
■ Ideal Body Weight
IBW = 50kg + 2.3kg (for each inch over 5 feet)
IBW = 50kg + 2.3kg (7in)
IBW = 66 kg
 ■ Percent Ideal Body weight = 30 ml/ kg/day or 1.3ml/kcal
%IBW = (ABW / IBW) x 100% =1740ml/day
%IBW = (58kg / 66) x100% 5 grams pf dextrose per 100 ml
%IBW = 87.88 % =1740 ml x 5 grams/100ml= 87 grams x
3.4 kcal/g
■ (>30% = no need for Adjusted Body
Weight Computation) =295.8 or 296 kcal
Computation for Basal Metabolic Rate Summary
(Harris- Benedict Equation)
TCR=2589 kcal minus 296 kcal (from IV
BMR = 66 + (13.7 x ABW in kg) + (5x ht. in cm) dextrose)=2293
– (6.8 x age by years)
CHO=1570 kcal
BMR = 66+ (13.7 x 58 kg) + (5 x 173.736 cm) –
CHON= 348 kcal
(6.8 x 59 y/o)
FATS= 675 kcal
BMR = 66+ 794.6 + 868.68 – 401.2
BMR = 1328 CHO= 61 % = 392 grams
CHON= 13% = 87 grams
■ Total Caloric Requirement
FATS= 26 %= 75 grams
TCR = 1328x 1.6 x 1.5
Composition of Food Exchanges
TCR = 1328 x 1.3( very light) x 1.5(severe
stress, trauma) FOOD NO. CH CH FAT ENE
OF O ON GR RGY
TCR = 2589 kcal
EXHA GR GR AM KCA
NGES AM AM S L
S S
Distribution VEG 6 9 3 48
A
a. Protein requirement
VEG 10 30 10 160
1.5 (severe stress)/kg x 58 = 87 grams B
of CHON FRUIT 12 120 480
= 87 x4= 348 kcal of CHON S
b. Non-CHON requirement: MILK 2 24 16 20 340
TER- kcal from CHON 15 75 300
=2589– 348= 2241 kcal SUGA
70 % from CHO and 30 % from fats: R
Carbohydrates 392- PARTI 258 29 20
2241 x .70= 1568.7 or 1570 kcal 258= AL
From CHO 134/2 SUM
=392 grams CHO 3=5.8
FATS OR 6
2241 x .30=672.3 0r 675 kcal from fats RICE 6 138 12 600
=75 grams fats 87- PARTI 42
42= AL
Fluid requirement (D5NSS): 45/8= SUM
5.6
OR 6

MEAT 6 48 42 570
Lunch
75- PARTI 62
62= AL Exchange Food Measure
13/5 SUM
=2.6 Veg A 2 Green 1 cup,
OR 3 papaya cooked
FATS 3 15 135
TOTA 396 90 87 2633 Veg B 4 Carrot 2 cups ,
L raw

Fruit 4 Mango, ripe 4

Distribution of Meals and Snack in days medium
slice 11
Exchange No. of Breakfast Lunch Dinner x 6 cm
group Exchanges Milk
Rice 2 Lugaw, 2 cups
Veg A 6 2 2 2
thick
Veg B 10 3 4 3 Meat 2 Vienna 8 pcs 5
Fruit 12 4 4 4 sausage x1½
Milk 2 1 1 cm1
Sugar 15 Fat 1 Mayonnaise 1 tsp
Rice 6 2 2 2 Dinner
Meat 6 2 2 2
Exchange Food Measure
Fat 3 1 1 1
Veg A 2 Sayote, 1 cup,
bunga cooked
Breakfast
Veg B 3 Kalabasa, 1 ½ cup,
Exchange Food Measure
bunga boiled
Veg A 2 Upo 1 cup,
(bottle boiled Fruit 4 Saging, 4 small
gourd) Latundan 10 x 4
Veg B 3 Ripe 1 ½ cup, cm
squash boiled Milk 1 Yoghurt ½ cup
Rice 2 Sweet 2 pcs.
Fruit 4 Apple 3 small-
potato Boiled 8
6cm
½x5
diameter
cm
Milk 1 Whole 1 cup
Meat 2 Egg soft 2 pcs.
milk
boiled
Rice 2 Cooked 1 cup,
Fat 1 Avocado ½
rice packed
green Medium
Meat 2 Corned 6 tbsps
12 x7
beef
cm
Fat 1 butter 1 tsp