Medical Nutrition Therapy in Patient With Multiple Fractures, and Liver Injury With Hypoalbuminemia Complications and Moderate Protein Energy Malnutrition: A Case Report

OBJECTIVES: The mandibular bone is a place of attachment for the muscles of mastication that are actively moving so that it can make it difficult for the patient to carry out the process of chewing food. METHODS: A 29 years old male with diagnosis multiple fracture due to a traffic accident. The patient experienced a decrease in oral food worsened 2 days ago because he was difficult to open his mouth due to severe pain when opening his mouth. Looks like a post-surgery wound Mandibular ORIF on the left side of the mandibular region, postoperatively. Exploratory Laparotomy + Liver Repair” in the abdominal. On laboratory examination found the metabolic status Normochromic Normocytic Anemia (11,4), leukocytosis (13,600), thrombocytopenia (143,000), increased NLR (5.42), elevated transaminase enzymes (543/675), Azotemia (1,44), mild hypoalbuminemia (3,0). RESULTS: Medical nutrition therapy is given gradually according to the patient's eating tolerance, starting from giving 1350 Kcal via oral in the form of semi-liquid food because the patient still has difficulty chewing there until it reaches 2700 Kcal which is assisted by parenteral nutrition. The composition of the macronutrients given. The patient was given oral supplementation in the form of zinc, curcuma, Vitamin A, C, D and snakehead fish extract capsules. The patient was discharged after 12 days of treatment with improved food intake (achieved 100% KET), there was no decrease in anthropometric parameters, the postoperative wound looked dry and improved metabolic status in the form of a decrease in leukocytes towards normal (8.3 × 103/mL), improvement in blood levels platelets (438.000), immune system improvement (1402.9/mL), liver function improvement (43/95), Improvement of kidney function (0.57). CONCLUSIONS: Optimal postoperative wound care and adequate medical nutrition therapy with dietary modifications can improve the patient's clinical condition including reducing the inflammatory reaction that occurs and improving the quality of life of patients treated with postoperative repair of mandibular fractures and fractures of the radius/ulna and liver injury due to blunt abdominal trauma. FUNDING SOURCES: Institutions from Department of Nutrition, Faculty of Medicine, Hasanuddin University.