CasePatient X is a 55-year-old man, 72 inches tall, weighing 86 kg, status post motor vehicle accident with multisystem trauma. The patient is currently receiving sedation, pain control, and maintenance IV fluids; he received 3 liters of NS bolus, 2 units of FFP, and 2 units of PRBCs on admission. On admission, labs included CRP -2.1mg/dL, Alb -4.5 gm/dL and transthyretin (TTR, prealbumin) -17mg/dL. Labs on day three showed that the CRP was 37 mg/dL, Alb 1.2 gm/dL, and transthyretin 10 mg/dL. In an overall assessment of the patient, the clinician states that based on the most recent labs, enteral or parenteral nutrition needs to be started due to malnutrition as indicated by his low albumin.
DisCussion
Malnutrition in the iCuMalnutrition is very common in critically ill patients, and its development is a function of the patients' preexisting nutritional status and severity of illness (degree of hypermetabolism). The characteristics of ICU patients have changed during the last decade; they now tend to be older and their medical disorders more complex with frequent comorbidity. These factors may contribute to malnutrition in the ICU. The combination of stress and undernutrition is associated with negative energy balances and the loss of lean body mass 1 . Critically ill patients often have a history of decreased food intake from anorexia, gastrointestinal symptoms, depression, anxiety, and other medical and surgical factors on presentation. Their food intake may have also been restricted for diagnostic or therapeutic procedures during hospital stay, and they may have nutrient loss from diarrhea, vomiting, polyuria, wounds, drainage tubes, and renal replacement therapy 2,3 .The major physiologic change
