Nutritional Therapy in Hyperosmolar Hyperglycemic State Patients with Severe Malnutrition: A Case Report

I Gusti Ayu Sintya Sevadani; Ni Made Dwi Asti Lestari

Authors

I Gusti Ayu Sintya Sevadani Departemen Gizi Klinis, Rumah Sakit Umum Daerah Bali Mandara, Bali
Ni Made Dwi Asti Lestari Departemen Gizi Klinis, Rumah Sakit Umum Daerah Bali Mandara, Bali

Keywords:

diabetes mellitus, hyperosmolar hyperglycemic state, malnutrition, nutritional therapy

Abstract

Hyperosmolar Hyperglycemic State (HHS) is a complication of Diabetes Mellitus (DM). Hyperglycemia can lead to weight loss due to glycosuria. If this problem is not resolved, this can lead to malnutrition. A 34-year-old woman presented with complaints of weakness, fever, pain during urination, decreased food intake, nausea, and vomiting. The patient has a history of DM. She was diagnosed with HHS, urinary tract infection, and electrolyte imbalance. Nutritional assessment showed a body mass index of 14.2 kg/m² with a weight loss of 11.1%. The patient has severe malnutrition. Nutritional therapy was provided with a target energy of 1,900 kcal/day and 50 grams of protein/day. Starting with a soft diet and then regular diet, ONS (low glycemic index), vitamin B6, and curcuma. According to ESPEN guidelines, patients with DM and malnutrition should receive a high-energy and high-protein diet. ONS should contain lower carbohydrate levels to reduce the glycemic index and provide high protein. In this case, the patient received ONS containing protein and complex carbohydrates with a low glycemic index. Vitamin B6 was given to support insulin and glucagon secretion in the pancreas and increase immunity, while curcuma was given to lower fasting blood sugar and protect the gastrointestinal tract. Implementation of a diabetic diet with a low glycemic index, combined with high energy and high protein for malnutrition, resulted in significant clinical improvement. The patient's blood glucose level decreased from 994 mg/dL to 176 mg/dL.

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