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Case Study
JB is a 45 year old white male who works as a roofer for a building contractor. He fell from a third floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take foods orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. JB had mild diarrhea when the tubefeeding was first initiated, but this resolved after 2 days.. At the time of admission, JB was 5'8" tall and weighed 167 lbs, his usual body weight.

One month later, JB, who was still comatose, was transferred to an extended care facility. By this time he weighed 142 lbs. A PEG line was inserted and full strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip.

Lab work, enteral formula nutrient content, and questions follow.

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