A 43-year-old woman diagnosed with cervical cancer in 2007 was treated with brachytherapy and radiotherapy.
After presenting a clinical picture of actinic sigmoiditis and intestinal obstruction at the end of 2009, a Hartman intestinal resection was performed, resulting in discharge obstruction.
At that time the patient weighed 41.5 kg, 165 cm (BMI = 15).
During the subsequent period his weight fluctuated between 38 and 42 kg despite the nutritional follow-up suffering up to five admissions one of them due to intracavitary abscess and left intestinal fistula.
In November 2011 she underwent ileocecal resection with laterolateral anastomosis due to intestinal fistula.
Postoperatively, the patient developed secondary to imipenem and was admitted to the ICU.
The patient required parenteral nutritional support for 20 days.
In January 2012, the patient was admitted again due to multifactor grade III chronic renal failure. Nutritional treatment with a renal protection diet was established.
The clinical situation requires a new PN for 10 days due to uncontrollable vomiting and impossibility of oral intake.
In September 2012 she was readmitted due to a suprapuberty fistula, starting again PN with the objective of nutritionalizing the patient to face a new intervention, at that time, 169 cm = surgical re-nutrition kg.
On the thirteenth day, after gaining 4 kg, the patient developed an allergic condition that began with erythema and pruritus.
The antibiotic was discontinued (9 days with meropenem) and treatment with corticosteroids and antihistamines was administered.
The evolution remains torpid in the following hours, with the appearance of edema and difficulty breathing.
At that time, it was decided to discontinue NP with improvement in symptoms.
Given the essential need for preoperative nutrition, a protocol for reintroduction of PN is developed:
1.
Start of TPN with exclusive intake of amino acids, glucose and electrolytes, with an amino acid source different from the previous preparation.
Always start in the morning schedule with close monitoring of the patient.
2.
After 48 h, if there were no signs of allergy reappearance, add increasing amounts of lipids to the parenteral during the next 72 h.
3.
In case of good tolerance, evaluate the need to add vitamins and trace elements to the mixture.
PN was restarted with good tolerance and no complications, contributing towards day 4 complete PN with macronutrients and according to the patient's needs.
After objectifying nutritional recovery, surgical intervention was decided with poor postoperative evolution and need for admission to the Intensive Care Unit for the development of septic shock of abdominal origin and multiple organ failure that ends in the patient's death.
