Posted by Anonymous on Friday, March 22, 2013 at 11:58pm.
Mark is a 30yo businessman who was diagnosed with Crohn’s dz over ten years ago; otherwise, he’s a healthy guy. He’s been free of flare-ups for the past couple of years, but a recent business trip to Thailand (stress, new foods) may have been the trigger for his most recent flare-up, a particularly bad one which put him in your hospital and ultimately resulted in resectioning of his jejunum. Mark was NPO for 3d prior to surgery and 9d post-op; clearly an oversight (oops!) as a result of his being transferred from unit to unit in an effort to clear beds and match changes in staffing patterns as a result of the widespread flu-related shortages. He’s had some D10W here and there, but that’s it.
During your first examination of Mark, you’ve found that he’s developed a fistula in his lower abdomen. It’s determined that the fistula originates in his medial jejunum. You discuss the situation with your medical team and it’s decided that Mark should be put on total parenteral nutrition. Your intern has some more questions for you
Mark’s been NPO for over 12 days now. I bet he’s really hungry, so I’m going to start him on D25A8 @ 125mL/h. Any suggestions?
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