5/20/17-Resident has experienced a decline in meal intake the past week r/t UTI with ABT therapy. She denies any difficulty chewing or swallowing. Currently eating 25-50% of meals, which is down from her usual 50-100%. Weight taken on 5/3/17 was 136# and was stable between 133-138# for 180 days. IBW is 100#. BS range from 125-200. Labs-5/18/17: Na 146H; K 3.7; Cl 110; Hgb 11.2L; Hct 38L; BUN 25H; Creat 1.0; GFR >60; Glu 137H. Skin is intact. Needs: 1545-1854 Kcals (BWx25-30) and 49-62 grams of protein (BWx.8-1.0) and 1854 mL in 24 hours (BWx30); Meals provide approx. 700-800 Kcals and 22-27 grams of protein. Would benefit from nutrition supplement. Spoke with resident and she agreed to try our Diet House supplement.
Nutrition Diagnosis: Inadequate meal intake related to recent infection and ABT therapy as evidenced by leaving 50% or more of meals
Recommend: 1) 120 mL SF House Supplement tid-following each meal. 2) Weekly weights 3) Encourage fluids-give an extra 120 mL q shift. Follow prn.
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Dietitian Mentor 
If the resident has a decreased meal intake what is the benefit of a sugar free supplement? They are already not consuming enough .
I individually assess wether or not to use a regular or SF supplement. It depends on their A1C and prognosis. If the resident was debilitated with dementia and 2 ADL impairments, I may consider a regular supplement.
SF med pass 2.0 supplement has 420 kcal’s per 8oz
Regular med pass 2.0 has 480 kcal’s per 8oz
The calorie difference in not significant.
Often times, I make recommendations in steps, choosing a SF supplement first and maybe changing it to a regular supplement down the road when all other attempts to stop the weight loss have been made. Of course, it’s all clinical judgement and RDNs may have a slightly different way of handling a situation. We need to assess if the benefits with going to a regular supplement outweigh the risks.