Essential role of nutritional support in patients with advanced carcinoid heart disease

#3542

Introduction: Chronic heart failure leads to cachexia in 5-15% of patients. Malnutrition affects 58% of patients with carcinoid syndrome.

Aim(s): Here we describe 2 cases with contrasting outcomes.

Materials and methods: 74M: Fit but losing weight. weight 63.1kg and BMI 19.05 (normal 84 & 24.81). Mid-arm circumference (MAC) 25cm, triceps skin fold (TSF) 3.8cm, mid arm muscle mass (MAMM) 23.8cm (10-25th centile). Hand grip strength (HGS) high at 43kg. Energy requirements 2163-2472kcal (35-40kcal/kg) and 1.5g/kg protein: 92.7g. BO 3-4 x daily, oily loose, yellow; stopped Creon earlier due to side-effects. Plan: Ensure plus changed to Fortisip compact protein 4 x daily, Nutrizyme 22 started. Further 4kg weight loss over 5 days despite reasonable appetite. Severe catabolic state so NG inserted. Started 500ml peptisorb, increased to 1L daily 3 days later, Pancrex V for enteral use. Switched to Fortisip compact. Increase dose of Nutrizyme to 4-5 with meals and 1-2 with supplements. Weight stabilised and HGS improved to 45kg. Had heart valve replacement surgery – TVR, PVR, PFO closure and LAA excision. 74F: Frail, weight 46.5kg & BMI 18.2 (normal 59kg), MAC 17cm, TSF 0.52cm, MAMM 15.3cm – all below 5th centile. HGS low at 12kg. Calculated energy requirements 1627 – 1860kcal (30-40kcal/kg) daily; protein requirement 55.8g daily. Poor appetite and not managing adequate intake. Patient refused NG feeding. Planned for oral sip feeds, and enhanced monitoring. Agreed to try NG feed 2 months later and tolerated well. Turned down for surgery due to frailty so local team decided to stop NG feeding after discussions with patient. She died 2 weeks later.

Conference:

Presenting Author:

Authors: Shah H, Mair R, Arif S, Smith S, Vickrage S,

Keywords: carcinoid syndrome, carcinoid heart disease, nutrition, nasogastric feeding,