A 32-year-old male, with no relevant past medical history and no previous treatment, who underwent surgery for splenic hiccup tear, mesennia and spinal cord injury due to spinal cord injury (SCI).
Resection of the colon, ileum, and 2/3 of the ileostomy and ileostomy is performed.
After the postoperative period and subjected to TPN, oral tolerance was initiated with oral infusions to caudates, oral pastes to stimulate enteral feeding with alkaline gel (WHO supplement) to introduce small and frequent intakes of glucose.
Six months later, anastomoses were performed at 12 cm of the common bile duct with the left colon and cholecystectomies were avoided in order to avoid subsequent biliary strictures.
Thereafter, the objective is to maintain a stable nutritional status, diuresis greater than liter/day and diarrhea control, daily balances being determined twice a week and biochemical parameters being assessed.
Nutritional behavior
It is structured as follows:
a Module) replaces the NOMs by 2 electrodes Isoplasma G® with addition of a 10 mEq/L ampoule and the vitamin module (Addamel®).
(b) Oral Enteral Nutrition: 4-5 "Elemental 0.28 Extra Fluid" intakes and 3 5 g "Adamin G" intakes are maintained by interacting with food intakes.
(c) Oral hygiene: prodigal, on demand and between meals, take "alkaline liquid".
(d) Allocation: with progressive criteria, starting with foods of easy digestibility and absorption and with less secretory stimulus to continue with those of greater difficulty.
From a diet lean toward meats, simple meat (HC) and cooked starches is now included, depending on the rate, volume and characteristics of feces, protein foods (soft vegetables and meats).
In any case, small, frequent and easily prepared meals are available.
(e) Medication: to reduce chlorhydropeptic acid and stimulate pancreatic water and bicarbonate secretion (40 mg/day) and to facilitate digestibility of natural foods® 10,000 associated enzymes and their availability 2K capsules
The appearance of abdominal discontent due to the consecutive installation of the HC excess in the first phase accelerated the transition to a normal feeding: cold, cold, and moderate control of the HC animals
Three months after jejunocolic anastomosis nutritional stability, diuresis and 4-6 liquid-pastose consistency stools are maintained.
The patient was discharged with the referred treatment and a reservoir for nocturnal fluid therapy with Isoplasmar G as a function of diuresis.
Evaluated by the intestinal transplantation unit of the Hospital Ramón y Cajal of Madrid and 14 months after starting enteral nutrition, the indication for transplantation is rejected due to good nutritional status.
Fluid therapy was suspended maintaining diuresis above 1,200 mL/day, 3-5 stools of pasty consistency or shaped (according to type of intake), and stable anthropometric and analytical parameters with hypolipemia.
The rapid loss of 7-8 kg after fluid therapy withdrawal stands out, finally reaching 64 kg for a height of 175 cm and a usual weight of 70 kg.
With their own autonomy, they maintain moderate physical activity.
Follow a frequent free diet and small intakes, only limited by specific intolerances, and often eat mineralized beverages.
You have been prescribed: "Elemental 0.28 Extra Fluid" (800 kcal/day), 2 capsules of "Kreón 10,000®" with each food intake, 2 tablets of "Supradyn"
Throughout the evolution, vitamin D, B12 and ac depletion was detected.
Fluid; they were corrected with the corresponding shock dose.
Tables I, II and III record the analytical determinations of nutrients practiced during the period between 6 months after the intervention to the last performed, where a stable and progressive nutritional status within normality is observed.
