Supplementary Material for: The Impact of Caustic Ingestion on Nutritional Status: case report

Introduction: Caustic injuries remain a major public health concern. Nutritional status plays a pivotal role in determining the outcome. Unfortunately, nutritional care guidelines are not widely implemented in clinical practice, and decisions are often based on prior experience and local policies.

Case presentation: We present the case of an 83-year-old man who accidentally ingested alkali, resulting in severe caustic injury and subsequent complications that further deteriorated his nutritional status. The management of esophageal strictures necessitated constant adjustments to the nutritional strategies employed. The clinical evaluation revealed protein and energy malnutrition, accompanied by type 2 intestinal failure. However, with individually tailored parenteral nutritional therapy, a significant improvement in the patient's nutritional status was observed.

Conclusion: Recognizing that caustic injuries increase metabolic demands, a comprehensive and active nutritional assessment is crucial, focusing on the need for adequate energy, high protein intake, and an appropriate feeding route. In cases of acute or prolonged type 2 intestinal failure with insufficient oral or enteral nutrition, parenteral feeding should be the primary therapy. Effective management of caustic injuries requires a multidisciplinary and multicenter approach, integrating nutritional evaluation, including body composition measurements, into the clinical algorithm. Early initiation of nutritional therapy is vital to prevent chronic intestinal failure.

引言：腐蚀性损伤（caustic injuries）仍是重大公共卫生问题。营养状况对疾病预后起着关键作用。遗憾的是，营养护理指南在临床实践中并未得到广泛推行，诊疗决策往往基于既往经验与当地政策。

病例报告：本文报告1例83岁男性患者，因意外摄入碱剂导致严重腐蚀性损伤，后续并发症进一步恶化其营养状况。食管狭窄（esophageal strictures）的治疗需不断调整所采用的营养策略。临床评估显示患者存在蛋白质能量营养不良（protein-energy malnutrition），并发2型肠功能衰竭（type 2 intestinal failure）。然而，通过个体化定制的肠外营养治疗（parenteral nutritional therapy），患者的营养状况得到显著改善。

结论：鉴于腐蚀性损伤会增加机体代谢需求，全面且积极的营养评估至关重要，需重点保障充足的能量摄入、高蛋白饮食以及选择合适的喂养途径。对于存在口腔或肠内营养（enteral nutrition）摄入不足的急性或持续性2型肠功能衰竭患者，肠外喂养应作为主要治疗手段。有效的腐蚀性损伤管理需要多学科、多中心的协作模式，将包括身体成分测量在内的营养评估纳入临床诊疗流程。尽早启动营养治疗对于预防慢性肠功能衰竭至关重要。