Volume 8, Issue 1 p. 52-58
Review

Nutrition in the hospitalized patient

Lisa L. Kirkland MD, FACP, MSHA, CNSP

Corresponding Author

Lisa L. Kirkland MD, FACP, MSHA, CNSP

Division of Hospital Medicine, Mayo Clinic, Rochester, Minnesota

Telephone: 507-358-6490 (cell), 507-255-8715 (office); Fax: 507-255-9189;

Division of Hospital Medicine, Mayo Clinic, 9702 Thunderbluff Rd NW, Oronoco, MN 55960Search for more papers by this author
Deanne T. Kashiwagi MD, MS, FACP, SFHM

Deanne T. Kashiwagi MD, MS, FACP, SFHM

Division of Hospital Medicine, Mayo Clinic, Rochester, Minnesota

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Susan Brantley MS, RD, CNSC, LDN

Susan Brantley MS, RD, CNSC, LDN

Department of Pharmacy, University of Tennessee Medical Center—Knoxville, Knoxville, Tennessee

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Danielle Scheurer MD, MSCR, SFHM

Danielle Scheurer MD, MSCR, SFHM

Department of Medicine, Medical University of South Carolina, Charleston, South Carolina

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Prathibha Varkey MBBS, MPH, MHPE

Prathibha Varkey MBBS, MPH, MHPE

Department of Medicine, Mayo Clinic, Rochester, Minnesota

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First published: 12 October 2012
Citations: 77

Abstract

Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris-Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine