In surgical patients requiring parenteral nutrition, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend initiating early parenteral nutrition when oral/enteral nutrition cannot provide adequate intake, specifically when intake falls below what percentage of estimated energy requirement for more than 3 days?
- A Below 75%
- B Below 60% ✓
- C Below 50%
- D Below 25%
Explanation
Current ESPEN perioperative guidelines recommend that parenteral nutrition should be initiated in surgical patients when enteral nutrition is insufficient and estimated energy intake is below 60% of requirements for more than 3–7 days (the threshold varies slightly by guideline version but 60% is the standard ESPEN threshold). This balances the risk of overfeeding/complications from PN against the risks of progressive nutritional depletion. The 'permissive underfeeding' concept (75%) applies to critically ill ICU patients under some protocols, but surgical nutrition guidelines use 60%.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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