TY  - CHAP
M1  - Book, Section
TI  - Nutrition and Metabolic Support
A1  - Kim, Dongwook
A1  - Seres, David S.
A2  - Lee, Kiwon
PY  - 2012
T2  - The NeuroICU Book
AB  - A  71-year-old  Caucasian  man  was  brought  to  the  emergency  department  (ED)  for  left-sided  weakness  and  confusion.  According  to  his  wife,  he  was  found  on  the  floor  in  his  bathroom  at  home  with  a  paralyzed  left  arm  and  leg  and  slurred  speech.  This  was  6  hours  before  he  came  to  the  ED.  The  patient  has  a  history  of  non–insulin-dependent  diabetes,  hypertension,  and  hyperlipidemia.  On  arrival  to  the  ED,  he  was  confused  and  was  noted  to  have  left  hemiparesis  and  left  facial  droop  with  aphasia.  The  vital  signs  revealed  a  blood  pressure  of  119/60  mm  Hg,  pulse  of  119  beats  per  minute  (bpm),  respiratory  rate  of  (RR)  33  breaths/min,  and  arterial  oxygen  saturation  (Sao2)  of  85%.  He  was  intubated  and  ventilated  after  appropriate  sedation  and  chemical  paralysis.  A  noncontrast  computed  tomography  (CT)  scan  of  the  head  was  performed,  which  showed  a  dense  right  middle  cerebral  artery  sign  and  no  evidence  of  acute  intracranial  hemorrhage.  The  electrocardiogram  revealed  atrial  fibrillation.  The  radiograph  of  the  chest  revealed  appropriate  endotracheal  tube  position  and  a  right  lower  lobe  infiltrate.On  his  arrival  in  the  neurologic  intensive  care  unit  (ICU),  his  vital  signs  showed  a  temperature  of  36.4°C  (97.5°F),  pulse  of  132  bpm  (sinus),  respirations  (ventilated)  at  14  breaths/min,  blood  pressure  of  113/47  mm  Hg,  and  oxygen  saturation  of  100%.  On  physical  examination,  he  appeared  acutely  ill  and  cachectic.  The  carotid  pulses  were  equal,  and  there  were  no  bruits.  A  pulmonary  examination  demonstrated  right  lower  lobe  crackles.  The  heart  sounds  were  normal.  The  limbs  were  well  perfused,  and  the  abdomen  revealed  diminished  bowel  sounds  with  a  soft  and  nondistended  abdomen.  A  musculoskeletal  examination  showed  moderate  diffuse  muscle  wasting.  The  neurologic  examinations  were  not  informative  because  of  deep  sedation.  The  results  of  laboratory  tests  are  shown  in  Table  51-1.According  to  his  wife,  he  retired  a  year  ago  from  his  previous  occupation  as  a  taxicab  driver  for  40  years.  He  had  been  smoking  1  pack  of  cigarettes  per  day  on  average  for  35  years  and  drank  alcohol  occasionally.  For  the  last  5  months,  his  appetite  has  been  decreased  and  he  has  been  eating  small  portions  at  2  to  3  meals  per  day.  He  lost  15  lb  (6.8  kg)  during  the  past  5  months  and  his  most  recently  measured  weight  was  115  lb  (52  kg).  His  height  was  5  feet  and  8  inches  (172  cm).  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - neurology.mhmedical.com/content.aspx?aid=1101646033
ER  -