(P24-005-25) Nutrition Management for a Patient With Sleeve Gastrectomy and Severe Malnutrition on ECMO

Objectives: Sleeve gastrectomy is the most commonly performed metabolic surgery in adults in the United States. Patients are at risk for nutrition deficiencies within the first year of surgery if they do not tolerate diet advancement or comply with supplementation recommendations.

Methods: A 39-year-old female with a history of a recent sleeve gastrectomy was admitted with a chief complaint of acute heart failure. She experienced rapid, severe weight loss of 30 percent of her body weight within 4 months after the surgery. She presented to a hospital after a fall and was brought to the operating room for an emergent aortic valve replacement and required central extracorporeal membrane oxygenation (ECMO) cannulation. The patient was transferred to an intensive care unit at a large regional hospital on ECMO and was diagnosed on admission with severe malnutrition due to inadequate intake. She received enteral nutrition (EN) support for 52 days until she could tolerate a regular diet. A screening for micronutrient deficiencies found no deficiencies as the patient complied with her supplementation regimen after her sleeve gastrectomy.

Results: Clinical guidelines recommend that patients with a history of bariatric surgery are evaluated and treated for nutrition deficiencies. Indirect calorimetry (IC) is recommended to determine energy needs; without IC, a bodyweight-based simplistic formula can be used for patients on ECMO. The patient received 25 calories/kilogram with 1.5-2.0 grams/kilogram of protein while on ECMO; indirect calorimetry was performed when she was stable. The patient received >85% of her estimated calorie and protein needs during hospitalization.

Conclusions: Patients within 1 year of metabolic surgery are at risk for malnutrition and micronutrient deficiencies if not taking recommended supplements and must be appropriately screened and assessed considering their surgical history for nutrition risks during critical illness.

Funding Sources: N/A