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Refractory breathlessness in advanced COPD — SCE Geriatric Medicine MCQ

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HardPalliative careRefractory breathlessness in advanced COPDSCE Geriatric Medicine

A 52-kg older adult has BMI 15.2 kg/m² and negligible intake for 12 days after bereavement. ECG is normal and electrolytes are low but replaceable. What initial nutrition prescription is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start about 520 kcal/day plus thiamine 200–300 mg and electrolyte replacement

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

B is correct. She is high risk but not in the NICE extreme examples of BMI below 14 or negligible intake over 15 days, so the maximum start is 10 kcal/kg/day: 52×10=520 kcal/day, with thiamine 200–300 mg and electrolyte supplementation alongside feeding. A applies the 5-kcal extreme-risk regimen. C feeds too fast. D underdoses and mistimes thiamine. E unnecessarily delays nutrition; pre-feeding correction is not required.

Reference: NICE CG32 adult nutrition support: https://www.nice.org.uk/guidance/cg32/chapter/Recommendations