Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient

Vitamins, Electrolytes and Minerals

Prophylactic Vitamin Supplementation

All patients with malnutrition should be started on these prophylactic vitamin/mineral supplementation upon admission for 8 weeks.
In cases of readmission: Re-prescribe if still within 8-week timeframe of supplementation.
For additional information on multivitamin products, please refer to the formulary.

Multivitamin

Age	Supplementation
< 13 yrs	Pediatric MVI
≥ 13 yrs	Adult MVI

Thiamine

Cofactor in carbohydrate metabolism, glucose utilization and is required to make ATP. Depletion may occur within 2 weeks of poor dietary intake since the body is unable to store thiamine.
Supplement for 8 weeks.
CHOP Formulary availability: 100 mg tablets.

Weight	Dosing
< 40 kg	50 mg PO/day
≥ 40 kg	100 mg PO/day

Zinc

Supplement for 8 weeks
CHOP Formulary availability: Zinc gluconate, 30 mg elemental zinc tablets

If Patient is on Chewable MVI (eg Flintstones) or Adult MVI with Zinc

Weight	Dosing
< 25 kg	No additional supplementation
≥ 25-39.9 kg*	15 mg PO/day
> 40 kg	30 mg PO/day

If Patient is Not on MVI

Weight	Dosing
< 25 kg	15 mg PO/day
≥ 25-39.9 kg*	30 mg PO/day
> 40 kg	45 mg PO/day

*If a patient is borderline/just under 40 kg and anticipated to gain to 40 kg quickly, can prescribe dosing for > 40 kg (may receive a call from pharmacy and have to override)

On Admission

All patients with malnutrition should have these vitamins/minerals levels measured since they are at risk for developing deficiencies due to their inadequate intake:

Ferritin
Methylmalonic acid
25 OH vitamin D

Supplement if Deficient

In cases of readmission: re-prescribe if still within 8-week timeframe of supplementation

Lab	Supplementation Name	Supplementation Dosing
Ferritin	Ferrous sulfate	See formulary for dosing guidance
Methylmalonic Acid	Cyanocobalamin	If elevated: indicative of vitamin B12 deficiency PO 250 mcg cyanocobalamin daily
Vitamin D 25 OH	Cholecalciferol	Supplementation indicated < 30 mg/mL 50-125 mcg per day (2,000-5,000 units per day)

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