IT Quiz Answer – Jun 13, 2024

Laurence is a 65-year-old male admitted with a hemorrhagic stroke. He is intubated, sedated, and has a nasogastric tube in place. His past medical history includes hypertension and type 2 diabetes. His height is 162 cm and his weight is 84 kg. Relevant medications include senokot and a propofol drip infusing at 11 mL / hour. He has not received any nutrition support over the past day. 

His blood glucose point-of-care measurements over the past 24 hours have ranged from 132–174 mg / dL, for which he has received 32 units of sliding scale insulin coverage.

Which tube-feeding formula is most appropriate for Laurence?  

1. A diabetic (carb-controlled) formula with a calorie density of 1.5 calories per mL 

2. A diabetic (carb-controlled) formula with a calorie density of 1.2 calories per mL 

3. A standard formula with a calorie density of 1.5 calories per mL  

4. An immune-enhancing formula with a calorie density of 1.5 calories per mL  

Answer: Laurence has a past medical history of diabetes, and his blood glucose while not receiving any nutrition has already been somewhat elevated, for which he has received 32 units of insulin. Once tube feeds are started, we expect his blood glucose to increase even further, therefore a carb-controlled tube feeding formula would be the most appropriate starting point for him. Because Laurence isn’t struggling with heart failure, chronic kidney disease, or any other disease states where free water would need to be restricted, it doesn’t matter whether he receives a more compact formula with a calorie density of 1.5 kcal / mL or a less compact formula with a calorie density of 1.2 kcal / mL. A standard formula with a higher amount of carbs would be less ideal for this patient as it could contribute to higher blood glucose, and an immune-enhancing formula isn’t necessary as there is no infection present. Additionally, immune-enhancing formulas aren’t carb-controlled and wouldn’t help Laurence’s blood sugar levels.