As you prepare to leave your medical office, you get a phone call from a patient’s family. The patient is a 59 year-old white male. The patient’s wife reports that the patient has been increasingly anxious and confused lately. He has been forgetful over the past three months. He has been inventing stories about people and places she never heard about before. Sometimes he has difficulty figuring out where he is located and what he is doing. He is unable to walk by himself. Even with assistance, he walks with a wide-based, short-stepped gait. He sees things other people do not see. He gets extremely agitated for very simple matters. He reported that he cannot feel his shoes when he wears them. This morning he complained of double vision and uncontrollable movements of his eyes from side to side. His past medical history is significant for hypertension. His surgical history is significant for appendectomy when he was 12 years-old and for bariatric surgery 3 years ago. At this time, he took some alcohol to ‘calm his nerves’ and went to bed. Patient’s wife would like to know what she can do for her husband?
Of the following, which serum vitamin level is reduced in refeeding syndrome due to its involvement in glucose metabolism, thus requiring supplementation?
While treating a patient with severe malnutrition with nutritional repletion, the risk of refeeding syndrome is greatest during which of the following time periods?
A 34 year-old female is brought to your office by her husband and children for evaluation. For many months she was not eating well because she believes that evil spirits enter her body mainly through food. A week ago, the family was able to convince the patient to eat and drink and with the help of a visiting nurse, they are feeding her with Ensure nutrition shakes they bought in the local pharmacy. They were amazed by the amount of calories she is taking on a daily basis. However, today she is complaining of loss of ability to move her upper and lower extremities. From home nurse notes, her vital signs at home a week ago were, Height = 5’1, Weight = 82 pounds, BMI = 15.5, temperature is 97 ⁰ F, heart rate is 44 beats per minute, respiratory rate is 18 breaths per minute, and blood pressure is 80/55 mm Hg. In physical examination, you see a feeble, malnourished individual with very slow speech. She has difficulty moving her upper and lower extremities. Today her vital signs are temperature is 99.8 ⁰ F, heart rate is 84 beats per minute, respiratory rate is 15 breaths per minute, and blood pressure is 110/75 mm Hg (lying), and 89/64 mm Hg (standing). The family reports that they are ‘happy with the results so far’ because she gained 10 pounds over one week, and her BMI rose to 17.4. What is the next best step in the management of this patient?
