Propuesta de abordaje dietoterapéutico en un caso con sepsis de foco endovascular y lupus eritematoso sistémico: análisis crítico basado en evidencia científica.

Abstract

This case describes a 34-year-old woman with a history of systemic lupus erythematosus receiving immunosuppressive therapy who was admitted to the intensive care unit with endovascular-source sepsis, septic shock, and respiratory failure requiring invasive mechanical ventilation and norepinephrine. The objective was to develop a dietotherapeutic approach based on scientific evidence. The available clinical information was reviewed retrospectively, considering anthropometric and biochemical parameters as well as the pharmacological treatment received. The patient was at nutritional risk, as indicated by an NRS-2002 score of 3, in addition to a history of anorexia, decreased food intake, a hypercatabolic state, and inability to eat orally. Nutritional requirements were established progressively and according to clinical evolution. During the acute phase, an intake of 870 to 1,160 kcal/day and 69.6 g of protein was estimated, while for the post-acute phase an intake of 1,160 to 1,450 kcal/day and 87 g of protein was considered. Once relative hemodynamic stability was achieved, early enteral nutrition was proposed on a continuous basis with gradual increases, using a high-protein polymeric formula of 1.5 kcal/mL. The approach also included assessment of gastrointestinal tolerance, free water intake, prevention of refeeding syndrome, and monitoring of metabolic abnormalities. Likewise, the situations in which supplemental or total parenteral nutrition might be necessary were defined. Overall, nutritional management should be adapted to each phase of the disease and adjusted daily according to perfusion, gastrointestinal tolerance, electrolyte balance, and the patient’s functional recovery.