Dietetic Internship Week 24: Nutrition Care IV (Relief)

A few months ago, I recognized that I was hesitant to recommend vitamin D & calcium supplementation for patients who were on long-term steroid therapy, even though I knew about the drug-nutrient interaction in theory.

What helped me get over the fear of recommending vitamin D & calcium for patients was: a) researching more into the evidence for increased calcium losses and poor absorption as a result of steroid therapy, b) knowing that no other profession in the hospital (generally speaking) spends as much time caring about micro-nutrients as dietitians, and we are in the best position to ensure adequate dosing and appropriate duration of supplementation, c) my preceptor reminding me lots of times that making sure patients receive appropriate supplementation is a big deal, and that it is within the scope of practice for dietitians to make micro-nutrient recommendations.

So you’d think from this experience I would feel more confident recommending micro-nutrient supplementation. Actually, I still felt hesitant during my last week of relief to recommend thiamine for a patient with a history of alcohol use. I reflected on why I felt that way, and I think it’s mostly because I need to know WHY I’m recommending supplements. So I looked it up. I was reminded that a lack of thiamine (more likely in heavy alcohol users) is the cause of Wernicke’s encephalopathy and Korsakoff syndrome. I read about how Wernicke’s encephalopathy is under-diagnosed, and that oral thiamine are less effective than multiple-doses of IV thiamine for treatment of Wernicke’s encephalopathy. Then I finally accepted that if Wernicke’s encephalopathy is suspected, thiamine should be recommended — risks of death from Wernicke’s encephalopathy and risks of permanent brain damage exist, while risks associated with treatment are low.

So I’ve learned to always ask about the “why” when learning about a novel practice — otherwise I’m not comfortable adopting it as my own.

I passed my relief placement, much gratefulness to my preceptor for helping me throughout the last 6 weeks!

Next: onto research week!

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