Small bowel obstruction (SBO) is a partial or complete blockage of the small intestine preventing normal passage of gastrointestinal (GI) contents. Common causes of SBO include adhesions, hernias, tumors/malignancies, and inflammatory conditions. SBO leads to abdominal pain, distension, nausea, vomiting, malaise, dehydration, and lack of appetite. Persistent vomiting contributes to significant fluid, electrolyte, and nutrient loss, and catabolic stress. In the critical care setting, these effects have a greater significance in patients with underlying severe malnutrition. Reduced intake, nutrient malabsorption, and ongoing GI losses exacerbate energy and protein deficits leading to impaired immune function, delayed wound healing, increased morbidity and risk of excess complications, and increased length of stay. Early identification of nutrition risk and timely intervention are vital to mitigate complications including bowel ischemia, perforation, sepsis, and nutrient depletion. Evidence-based practice suggests parenteral nutrition (PN) as means of nutrition support when GI tract function is compromised or enteral nutrition (EN) is not tolerated or feasible due to excessive vomiting or required bowel rest. Cautious initiation and advancement of nutrition support and careful monitoring of electrolytes are critical to reduce the risk of refeeding syndrome in SBO patients with delayed nutrition support and underlying malnutrition. As the obstruction resolves, gradual reintroduction of oral intake is recommended through low-fiber and high-energy foods to support GI tolerance and nutritional status improvement. This case report explores the complex nutritional needs and goals of care in a patient with a SBO presenting with intractable nausea, vomiting, and pre-existing chronic severe protein-calorie malnutrition.

Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is among the most metabolically complex conditions encountered in the intensive care unit (ICU). Medical nutrition therapy (MNT) plays a critical role in mitigating the consequences of AKI and CRRT, including hypercatabolism, electrolyte shifts, fluid overload, and amino acid losses, ultimately influencing morbidity and length of stay. Evidence-based guidelines support early enteral nutrition (EN) initiation within 24-48 hours of ICU admission in hemodynamically stable patients. Indirect calorimetry (IC) is the gold standard for energy assessment, however in practice, a weight-based predictive equation is commonly utilized due to limited availability of IC equipment. A standard polymeric formula is the first-line option for EN infusion and a renal-specific formula may be indicated when potassium, phosphorus, or magnesium levels are elevated. Protein requirements are substantially elevated in patients receiving CRRT, ranging from 1.5 to 2.5 g/kg/day, reflecting both continuous amino acid losses and the heightened catabolic state. Supplemental protein modulars may be utilized to meet these increased demands without contributing excess fluid or electrolytes. Ongoing monitoring is essential for safe and effective MNT and should include daily renal labs (creatinine, blood urea nitrogen, electrolytes), 24-hour intake, weight trends, and assessment of fluid accumulation. This case report demonstrates the application of evidence-based, individualized MNT emphasizing timely EN initiation, adequate protein delivery, careful electrolyte management, and interdisciplinary collaboration to optimize clinical outcomes in critically ill patients receiving CRRT.

Diverticulosis is the formation of several small pouches, called diverticula, within the intestinal lumen. Diverticulitis occurs when these pouches become inflamed. Risk factors for diverticular diseases include a chronically low-fiber diet, genetic predisposition, hypertension, type 2 diabetes, and obesity. Uncomplicated diverticulitis is typically managed through bowel rest and pain management. However, complicated diverticulitis, such as cases involving an abscess or fistula, often require surgical intervention, which can significantly impact nutritional status through subsequent complications during a hospital stay. Patients often experience inadequate oral intake due to prolonged diet restrictions, abdominal pain, nausea, vomiting, and fever. As a result, these patients are at increased risk for malnutrition and unintended weight loss, all of which may negatively impact recovery. The diet recommendations typically begin with complete bowel rest during inflammatory periods, with the eventual goal of gradually progressing to a high-fiber diet to prevent future recurrence. However, in patients with complications, diet progression may be delayed, requiring the initiation of enteral or parenteral nutrition to meet calorie and protein needs. Early nutrition intervention is critical to prevent further weight loss. This case report examines the diet progression following a diverticulitis flare-up with placement of colostomy in a patient who presented with severe, chronic malnutrition.

The transcription factor, Nuclear factor erythroid 2-related factor 2 (NRF2), functions by activating genes that help protect the body against oxidative stress, inflammation, and various toxins. Thus, identification of small molecules that can increase NRF2 activity could be helpful to increase the body’s natural defense system against chronic disease. The goal of this interdisciplinary project is to use cell lines generated by the Montgomery lab (Nutrition) that express a fluorescent NRF2 reporter to test a small library of novel compounds generated by the Green lab (Chemistry) for their NRF2 activation capacity. First, our reporter system will be validated with known NRF2 activators. We will then use a luciferase reporter assay to screen 15 novel compounds for their capacity to activate NRF2 compared to the known standards. These data can then be used to inform both labs about their antioxidant capacity and help optimize their furthered development and utility.

Malnutrition is a prevalent concern in older adults with dementia, due to disease progression causing oral feeding difficulties such as lessened interest in food, forgetting how to eat, food hiding behaviors, and dysphagia. Decreased oral intake is part of the natural progression for dementia, but this can be difficult for families to understand, and they often seek more aggressive forms of nutritional intervention, such as enteral nutrition feedings (EN). Although EN is frequently indicated for malnutrition, it has controversial ethical concerns within dementia patients, with little to no clinical benefit shown, and risk of complications. Current guidelines for dementia nutritional care emphasize comfort feedings, removing barriers to eating difficulties when able, and respecting patients’ desires and autonomy. Recognizing that dementia is a progressive, terminal illness that will not improve even with nutrition interventions is vital when making nutritional considerations in care. Educating the patient and family members on comfort centered care, providing favorite foods, and the natural progression of nutritional decline in dementia is essential to guide decisions surrounding whether or not to use EN. This case report explores a clinical dietitian's care plan for a 90-year-old malnourished female with dementia and food hiding behaviors, and the ethical care considerations discussed with her family to promote quality of life.