Nutrition in the hospitalized patient.
Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris-Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting.
Division of Hospital Medicine, Mayo Clinic, Rochester, Minnesota 55960, USA. Kirkland.lisa@mayo.edu
Lisa L
LL
Kirkland
Deanne T
DT
Kashiwagi
Susan
S
Brantley
Danielle
D
Scheurer
Prathibha
P
Varkey
D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D019587:Dietary Supplements / Q000032:analysis; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods / Q000592:standards; D010347:Patient Care Planning / Q000458:organization & administration* / Q000592:standards; D055677:Refeeding Syndrome / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors