A 65-year-old man (70 kg, 175 cm, BMI 22.9) is in the ICU after severe septic shock. He remains hypermetabolic with acute kidney injury on continuous renal replacement therapy, hypoalbuminemia (2.0 g/dL), and a positive fluid balance of +5 L. His GI tract is functional (active bowel sounds, tolerates enteral medications), but fluid intake must be limited to ≤1000 mL/day. Which initial enteral formula best meets his nutritional needs?

A 58-year-old man with severe acute pancreatitis is in the ICU on mechanical ventilation and norepinephrine. He has received continuous enteral nutrition via a nasogastric tube for 3 weeks but continues to have high gastric residual volumes and multiple aspiration events despite prokinetic therapy. Given his need for prolonged nutrition and persistent gastric feeding intolerance, which of the following is the most appropriate long-term enteral nutrition plan?

A 65-year-old, 70 kg male is admitted to the ICU with septic shock. He is intubated on assist-control ventilation, receiving norepinephrine 0.1 mcg/kg/min, and undergoing continuous renal replacement therapy (CRRT) for acute kidney injury. His enteral nutrition prescription has been standard polymeric formula at 40 mL/hour (1.0 kcal/mL, 40 g protein/L) for 3 days, providing 960 kcal/day (13.7 kcal/kg/day) and 38 g protein/day (0.55 g/kg/day). Laboratory values: Na 138 mEq/L, K 5.8 mEq/L, phosphate 1.2 mg/dL, Mg 1.9 mg/dL, BUN 60 mg/dL, Cr 3.5 mg/dL. He receives a standard multivitamin but no additional water-soluble vitamin supplementation. Current nutrition targets are 25–30 kcal/kg/day and 1.5–2.0 g protein/kg/day for CRRT patients. Which of the following adjustments to his enteral nutrition plan is MOST appropriate?

A 62-year-old man with type 2 diabetes is admitted to the ICU with septic shock requiring mechanical ventilation. He is receiving enteral nutrition via a nasogastric tube with a standard polymeric formula (55% carbohydrate, 30% fat, 15% protein) at a goal of 2,000 kcal/day. Despite a continuous insulin infusion titrated to maintain blood glucose between 140–180 mg/dL, his point-of-care glucose readings remain persistently elevated at 200–240 mg/dL for the past 24 hours. After optimizing insulin therapy and confirming target caloric delivery, which of the following is the most appropriate second-line adjustment to his enteral nutrition regimen?

A 58-year-old man (height 175 cm, weight 80 kg; BMI 26 kg/m2) is admitted to the intensive care unit with severe septic shock requiring mechanical ventilation and vasopressor support via a central venous catheter. He is hemodynamically stabilized (MAP ≥ 65 mm Hg) but remains critically ill with intact gastrointestinal function. Early enteral nutrition is planned within 24 hours to preserve gut integrity and meet increased protein needs due to high catabolic stress. Considering his clinical status and the goal of preserving gut mucosal integrity, which of the following is the most appropriate first-line enteral nutrition formula to meet his increased protein demands?

A 68-year-old male patient has been in the intensive care unit for over 4 weeks following a severe stroke resulting in poor neurological prognosis and minimal chance of meaningful recovery. He has been receiving enteral nutrition via a nasogastric tube but is being considered for a percutaneous endoscopic gastrostomy (PEG) tube for long-term feeding. The critical care team is uncertain about the appropriateness of this invasive intervention given the patient’s prognosis. As the critical care pharmacist, you are asked to recommend the MOST critical initial step to guide the patient’s care plan regarding prolonged enteral nutrition support.

A 65-year-old man is in the medical ICU for severe sepsis requiring mechanical ventilation. He has a right internal jugular central venous catheter (CVC) in place, intermittent pneumatic compression devices applied bilaterally, and is receiving enoxaparin 40 mg subcutaneously once daily for pharmacologic VTE prophylaxis. He is not currently on stress ulcer prophylaxis and is receiving enteral nutrition at a protein dose of 1.0 g/kg/day. His INR is 1.5, platelets 110 × 10^9/L, and he remains on low-dose norepinephrine. To prevent common ICU complications (VTE, stress ulcer bleeding, catheter-related infection), which intervention should the critical care pharmacist prioritize?

A 58-year-old man with a history of alcohol-use disorder was admitted to the ICU with severe acute pancreatitis. He remained NPO for 7 days and was started on continuous enteral nutrition (20 mL/hour) 24 hours ago. Over the past 12 hours, he has gained 1.1 kg, developed peripheral edema, and now has the following labs: serum phosphate 1.3 mg/dL (2.5–4.5), potassium 2.9 mEq/L (3.5–5.0), magnesium 1.2 mg/dL (1.7–2.2), and normal glucose. As the critical care pharmacist, which of the following interventions is the highest priority to manage his emerging refeeding syndrome?

A 65-year-old male with septic shock is on assist-control ventilation and receiving a continuous norepinephrine infusion at 0.3 mcg/kg/min via a central line. He has been on continuous enteral nutrition (EN) at 40 mL/hr for the past 24 hours without signs of feeding intolerance (no abdominal distension or high gastric residual volumes). His vital signs are HR 115 bpm, BP 85/50 mmHg (MAP 62 mmHg), RR 20 breaths/min, SpO₂ 95%, and lactate is 3.5 mmol/L. Considering the patient’s current hemodynamic instability and vasopressor requirements, what is the MOST appropriate immediate action regarding his enteral nutrition?

A 62-year-old man in the ICU has a jejunostomy feeding tube placed because of prolonged mechanical ventilation and impaired swallow. He is receiving multiple IV medications. As the critical care pharmacist, you must convert suitable IV drugs to enteral administration via the jejunostomy tube. Considering the altered absorption characteristics of the jejunum and the need for tube patency, what is the MOST appropriate initial step in your conversion plan?