NUTRITIONAL MANAGEMENT OF CLINICALLY EVIDENT NUTRITIONAL DEPLETION DESPITE NORMAL BMI IN A PATIENT WITH DYSPHAGIA AND ACUTE KIDNEY DYSFUNCTION: A CASE REPORT

Abstract

Background:Malnutrition in hospitalized patients may remain unrecognized when nutritional assessment relies primarily on body mass index (BMI). Nutritional management becomes particularly challenging when reduced nutritional intake coexists with dysphagia, acute illness, and kidney dysfunction. This case describes the nutritional management of a patient with clinically evident nutritional depletion despite a normal-range BMI in the setting of multiple medical and nutritional challenges. Case presentation: A 57-year-old man was admitted with severe pneumonia, hypovolemia with hypernatremia, acute kidney injury with a differential diagnosis of acute-on-chronic kidney disease, neurological impairment, and flaccid paraplegia. He had experienced markedly reduced food intake for approximately one month because of generalized weakness, cough, and dysphagia. Nutritional assessment estimated a body weight of 55 kg and BMI of 20.95 kg/m². Despite a normal-range BMI, nutrition-focused physical examination demonstrated moderate muscle wasting and loss of subcutaneous fat. Nasogastric enteral nutrition was initiated at approximately 15 kcal/kg/day and progressively advanced toward an estimated target of 1,650 kcal/day. Protein provision was initially 1.0 g/kg/day and subsequently reduced to 0.6 g/kg/day in the context of kidney dysfunction. Thiamine supplementation, potassium correction, and monitoring of feeding tolerance, renal function, fluid status, and electrolytes were performed during nutritional advancement. Outcome:Estimated energy intake increased from approximately 600 kcal/day at the initial assessment to 1,387 kcal/day by nutrition day 6, corresponding to approximately 84% of the estimated target. Transient nausea, vomiting, and epigastric discomfort occurred during nutritional advancement but subsequently improved. Urine output increased to approximately 1,400 mL/24 hours, and hypovolemia was documented as resolved. However, objective reassessment of body weight, muscle mass, and functional capacity was unavailable during the short hospitalization. Conclusion:This case illustrates that clinically relevant nutritional depletion may occur despite a normal-range BMI. Comprehensive nutritional assessment and individualized enteral nutrition were important in addressing markedly reduced intake and dysphagia while accounting for kidney dysfunction and fluid-electrolyte disturbances. Nutritional management required progressive reassessment of energy and protein provision, feeding tolerance, and biochemical status rather than reliance on BMI or kidney function alone.