James A. Haley VA Hospital and Clinics, 13000 Bruce B Down BLVD, Tampa, FL, 33612, USA.
James A. Haley VA Hospital and Clinics, 13000 Bruce B Down BLVD, Tampa, FL, 33612, USA.
Clin Nutr ESPEN. 2022 Apr;48:275-281. doi: 10.1016/j.clnesp.2022.01.036. Epub 2022 Feb 2.
BACKGROUND & AIMS: COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports.
We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive.
The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive.
Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.
COVID-19 具有高度炎症性，当它影响到患有多种合并症的老年人时，营养不良的风险很高。本综述的目的是通过两个病例报告强调 COVID-19 与营养不良（宏观和微量营养素缺乏）的证据。
我们报告了两例 COVID-19 患者。第一个病例包括一名 75 岁男性，在 COVID-19 临床诊断缓解后，他出现了意识混乱、谵妄和营养不良。该患者有多种合并症，在住院前后均接受利尿剂治疗。他接受了静脉注射硫胺素和肠内营养治疗。第二个病例包括一名 77 岁男性，患有糖尿病，在被诊断为肺炎和 COVID-19 之前近两周，因慢性使用阿司匹林而疑似维生素 C 缺乏。该患者从 COVID-19 诊断中康复，但继续在营养方面下降，在 COVID-19 诊断后 60 天因营养失调再次入院。
在接受硫胺素输注和肠内营养治疗后，第一个病例的食欲和神经状况有了显著改善，在住院 19 天后出院回家。第二个病例在 COVID-19 检测呈阳性之前就出现了维生素 C 缺乏。尽管他从 COVID-19 中康复，但在 COVID 后难以满足营养需求，并在 COVID-19 诊断后 60 天因肺炎和营养失调去世。
患有慢性病且使用消耗营养药物的老年患者在经历 COVID-19 的炎症性损伤时，特别容易出现微量营养素缺乏。即使在病毒似乎临床缓解后，仍存在不良营养摄入的患者应密切监测。
