Laporan Kasus: Terapi Nutrisi Enteral pada Pasien Penyakit Paru Obstruktif Kronis Eksaserbasi Akut dengan Diabetes dan Pneumonia

Abstract

Acute exacerbation of Chronic Obstructive Pulmonary Disease with type 2 respiratory failure accompanied by diabetes mellitus and pneumonia represents a critical condition requiring adequate enteral nutrition therapy to meet metabolic demands, control blood glucose levels, and reduce respiratory workload. This case report aims to describe the standardized nutrition care process and evaluate the clinical, biochemical, and respiratory responses of the patient during intensive care in the Intensive Care Unit (ICU). The subject was a 56-year-old female admitted to the ICU supported by a mechanical ventilator. Initial assessment results showed severe hyperglycemia (random blood glucose 453 mg/dL and HbA1c 8,97%), respiratory acidosis with metabolic compensation (pH 7,193 and pCO₂ 82 mmHg), leukocytosis (13,18 thousand/µL), and radiographic findings of pneumonia on chest X-ray. Based on the 24-hour enteral food recall results, the patient experienced deficits in energy intake of 61%, protein 47%, fat 46.6%, and carbohydrates 82,5% of total requirements. The nutrition diagnoses established were inadequate energy and protein intake (NI-5.2) and altered laboratory values related to carbohydrates and respiratory function (NC-2.2). The nutritional intervention used a diabetes-specific formula on day 1, then continued with a different diabetes-specific formula from day 2 to day 7, and returned to the initial formula from day 8 to day 9. This diabetic formula contains high protein and low carbohydrate. Enteral nutrition was administered via a nasogastric tube with the volume increased gradually starting from 180 cc/4 hours. Monitoring results showed that the fulfillment of energy and protein intake increased approaching 100% of requirements from day 5 onwards. A favorable trend of improvement in clinical and laboratory parameters was observed, marked by a decrease in blood glucose to 226 mg/dL, improvement in arterial blood gas analysis with pCO₂ decreasing to 54 mmHg and pH normalizing to 7,471, and successful weaning from mechanical ventilation. In conclusion, enteral nutrition therapy based on a high-protein diabetes-specific formula integrated with intensive medical care plays an important role in supporting intake adequacy, glycemic control, and respiratory recovery in critically ill patients.