[An integrated approach to enteral and parenteral nutrition in intensive care: a case report]

Parenteral nutrition (PN), developed since the 1960s with the pioneering work of Dudrick, today represents a safe therapeutic option both as exclusive support and as an integration to enteral nutrition (EN). In critically ill patients, the risk of malnutrition is high due to profound metabolic alterations and nutritional therapy must be modulated according to the stage of the disease, avoiding both overfeeding and underfeeding. We present the case of a polytraumatized adolescent admitted to intensive care following a serious motorcycle accident. After an initial stabilization phase, early EN was initiated, increasing to 75% of the estimated caloric requirement. The onset of intolerance (vomiting and gastric stagnation - RG) associated with alterations in cholestasis and hepatic cytolysis indices necessitated reducing EN and considering alternative strategies. In the absence of improvement, supplemental parenteral nutrition (SPN) was initiated, with a high-protein mixture, prudent lipid modulation, and daily micronutrient supplementation. EN was maintained at a low dose for trophic purposes. With progressive clinical recovery, the reduction of RG, intestinal canalization, and EN were increased until reaching the caloric requirement, allowing the suspension of SPN and the subsequent transition to oral feeding. This case highlights how, in intensive care, EN and PN should not be considered hierarchical alternatives but rather complementary tools, to be modulated in a personalized and multidisciplinary manner. Targeted management ensures adequate nutritional intake, prevents complications, and improves clinical outcomes in critically ill patients.