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Does Lack Of Nutrition Affect Chances Of Survival When Suffering Fromheart Failure?
Question: Suppose an elderly patient has chronic heart failure, renal impairment, COPD, pneumonia, hypoxia, delirium, hypotension and is already malnourished. If, for some reason, the patient could not be given nutritional support, but was still suitable for IV fluid, would the lack of nutrition significantly affect the person's chances of surviving? I appreciate that in these circumstances it may be difficult to assess survivablility. But could you give a rough estimate as to how many days such a person might be able to survive without nutrition?
Brief Answer:
May be 10-30 days
Detailed Answer:
Hi
Greetings from Dr.Divakara.P
Thanks for choosing HealthcareMagic.
Definitely lack of nutrition has a bad effect on health and survival. More over in your patient it can really determine survival.
But what I would like to mention if your patient is suitable for IV fluids then even nutrition can be given through IV route. It's called Total parenteral Nutrition.
Prediction of length of survival needs further information on certain parameters. These are patients heart rate, blood pressure, urine output and ejection fraction. Kindly let me know these so that I can give you better prediction. But overall he has 10-30 days of time.
Any clarification feel free to ask.
Regards.
May be 10-30 days
Detailed Answer:
Hi
Greetings from Dr.Divakara.P
Thanks for choosing HealthcareMagic.
Definitely lack of nutrition has a bad effect on health and survival. More over in your patient it can really determine survival.
But what I would like to mention if your patient is suitable for IV fluids then even nutrition can be given through IV route. It's called Total parenteral Nutrition.
Prediction of length of survival needs further information on certain parameters. These are patients heart rate, blood pressure, urine output and ejection fraction. Kindly let me know these so that I can give you better prediction. But overall he has 10-30 days of time.
Any clarification feel free to ask.
Regards.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you Dr. Divakara for the very helpful information. Examples of recent BP are 107/69, 104/60, 112/69 & 102/62. Respiratory Rate: 19. Heart Rate: 92, 92 & 96. Temperature: 35.8C, 34.5C & 34.8C. This morning Venous Lactate was 4.1 mmol/L; p02 was 46 mmHG; and he was saturating on Room Air at 81%, although Sp02 later went up to 95%. I have no information about the urine output, since it is not being monitored. I forgot to mention that he also has Type 2 diabetes.
Also, as a general principle, is it a good idea for a patient who is hypernatremic (sodium 146 mmol/L & 157 mmol/L) to be on a normal saline IV fluid? However, he is on Lasix (frusemide) 120 mg BD.
Also, as a general principle, is it a good idea for a patient who is hypernatremic (sodium 146 mmol/L & 157 mmol/L) to be on a normal saline IV fluid? However, he is on Lasix (frusemide) 120 mg BD.
Brief Answer:
Saline not to be given .
Detailed Answer:
HI
Went through the details . Most of his vitals are in the normal range . Except for his Po2 . I need to know whether his PO2 was done in Venous Blood ( seems Venous only ) or Arterial Blood because if it’s Arterial blood then Po2 is very low then he will survive for 2-3 days. But if its Venous then his condition is stable though deteriorating slowly he still can live for 2-3 weeks .
It’s Not right to give Normal Saline for a Hypernatremic Patient . I advise to give IV dextrose as it give give some energy and also help in reducing Serum Sodium Levels .
Any clarification feel free to ask.
Regards.
Saline not to be given .
Detailed Answer:
HI
Went through the details . Most of his vitals are in the normal range . Except for his Po2 . I need to know whether his PO2 was done in Venous Blood ( seems Venous only ) or Arterial Blood because if it’s Arterial blood then Po2 is very low then he will survive for 2-3 days. But if its Venous then his condition is stable though deteriorating slowly he still can live for 2-3 weeks .
It’s Not right to give Normal Saline for a Hypernatremic Patient . I advise to give IV dextrose as it give give some energy and also help in reducing Serum Sodium Levels .
Any clarification feel free to ask.
Regards.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you greatly Dr. Divakara for the benefit of your expertise. The Venous p02 is 19 mmHg. I infer that the 46 mmHg is the Arterial Blood PO2. I don't know the significance of it, but his Base Excess (not the Venous Base excess) is also High at 8 mmol/L & his pH (not the Venous Base excess) is High at 7.50.
Brief Answer:
PO2 very less
Detailed Answer:
HI
Base excess of 8 is not very significant also Ph is mildly high , not of any concern . But a Arterial Blood PO2 of 46 is very low . He need Oxygen supplementation.
Just a question , is he being managed at home or hospital ?
PO2 very less
Detailed Answer:
HI
Base excess of 8 is not very significant also Ph is mildly high , not of any concern . But a Arterial Blood PO2 of 46 is very low . He need Oxygen supplementation.
Just a question , is he being managed at home or hospital ?
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you again Dr. Divakara. He is in hospital and is already on 02.
Brief Answer:
Use clear water through Ryle's tube
Detailed Answer:
Thanks for the information.
If Ryle's tube has been inserted , clear water also can be given through it. This will also help in bringing down his sodium levels apart from IV Dextrose.
Any further queries or clarification feel free to ask.
Happy to answer.
Regards.
Use clear water through Ryle's tube
Detailed Answer:
Thanks for the information.
If Ryle's tube has been inserted , clear water also can be given through it. This will also help in bringing down his sodium levels apart from IV Dextrose.
Any further queries or clarification feel free to ask.
Happy to answer.
Regards.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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