A 23-year-old patient diagnosed with ileal Crohn's disease.
It initially presents an inflammatory pattern that affects this type of tumor (occasionally sub-occurring crises), followed by perforating episodes, resulting in an abdominal perforation with surgical fecal peritonitis that led to 3 interventions.
Due to numerous postoperative complications, short bowel syndrome and enterocutaneous fistulae are common in our hospital.
On admission she presented with fever, wound infection with cutaneous manifestation and severe malnutrition.
She has a protective ileostomy, fistulization directed at the level of ileocolic anastomosis with Petzer tube and abdominal drains.
Since admission, total nutrition (TPN) is started gradually.
During the whole period the Nutrition Section of the Service monitored.
The TPN is prepared daily adjusting the contributions according to biochemical parameters and their clinical evolution.
After 7 days, the patient developed stasis, so it was decided to reduce and subsequently eliminate the contribution of lipids in the TPN.
On day 68, the TPN was removed due to the onset of oral tolerance, being reintroduced after 5 days due to persistent enterocutaneous fistula causing fever, abdominal pain and significant weight loss.
After removal of drainages and Petzer tube and introduction of treatment with Infliximab, on day 85 is discharged from hospital, continuing with TPN at home until recovery of nutritional status necessary for intestinal reconstruction.
The outpatient follow-up was carried out by the Hospitalization Unit at Domicilio (HADO) and the Nutrition Section of the Referral Office of Diseases.
The TPN is prepared daily in the Department of Integrated Management, and staff of the HADO Unit are in charge of its administration, maintenance of the infusion route and clinical follow-up of the patient.
Likewise, the patient and her family received instructions for the management of the administration team.
This allowed that despite the intrinsic limitations, the patient could adapt the administration of TPN to her daily activity.
In addition, a general biochemistry was performed every week, whose results allowed us to follow up the patient and modify the contributions according to their needs.
During this period, the daily intake (mean ± standard deviation) of macronutrients was 12.2 ± 0.62 g of nitrogen and 1,400 ± 71 kcal non-protein.
Regarding creatinine, the mean weekly intakes were: sodium 92 ± 14.2 mEq, chloride 82.6 ± 14.6 mEq potassium 100 ± 36.4 mEq, phosphorus 10.6 ± 1.3 mEq, calcium 7 ± 0.03mEq, magnesium 1
Mean change in biochemical parameters (mean ± standard deviation): glucose 95 ± 15.1 mg/dl (range 70-100), total urea 56 ± 25.1 mg/dl (range 10-50), total serum creatinine 1 ± 110dl (range 1.64)
After 7 and a half months with TPN at home, the patient with a BMI = 18.63 and a prealbumin of 32.9 mg/dl (range 20 to 4) underwent intestinal reconstruction, progressing favorably.
