Professional Documents
Culture Documents
Objectives
Participants will be able to:
Overview
How much?
When?
Where?
What?
And What now?
Pretransplant needs
Posttransplant Requirements
Posttransplant Needs:
DPEJ-
Semi-Elemental/Partially Hydrolyzed
Disease Specific
4 QUESTIONS WHEN
CHOOSING AN ENTERAL
FORMULA:
Is the functionality of the GI tract
compromised?
Is a semi-elemental formula needed?
Is there a need for a high protein
formula?
Is there a need for a water restriction?
Is there a need for a low electrolyte
formula?
When GI functionality Is
Impaired
Small peptides in the di & tri form may have
Protein Composition
Standard
Semi-elemental
Elemental
Fat Composition
Most semi-elemental formulas are lower in fat and high in mediumchained triglycerides (MCTs), to improved compromised absorption.
Soybean oil
Canola oil
Safflower oil
Corn and fish oils
Lecithin
Fat content may range from <10% to >50% of total calories in a formula
Fat Composition
Many of the semi-elemental formulas contain MCTs
MCTs are:
more water-soluble,
absorbed without bile emulsification and lipase for
micelle packaging
bypass the lymphatic system
Water Content
Water concentrations of formulas range from
Renal Formulas
Diabetic Formulas
Renal Formulas
Lower in electrolytes and volume
concentrated
Diabetic Formulas
Often lower in carbohydrate 34-40% of kcals, however,
Managing Complications of
Enteral Nutrition
Impaired Gastric Emptying
Diarrhea
Electrolyte Imbalances
Feeding Tube Occlusion
Diarrhea
Normal stool content 250-500ml/day. Diarrhea
has been defined as > 500ml every 8 hours or
>3 stools per day for at least 2 consecutive
days
Potential causes:
medications
GI disorders or dysfunction
malabsorption
fecal impaction
malnutrition
composition of feeding, rate of delivery
opportunistic infections
Diarrhea
Medication induced:
Diarrhea
Malnutrition:
Treatment of Diarrhea
Check for C diff or other infectious causes. Medical
Treatment of an Enteral
Feeding Tube Occlusion
Warm water flushing
Flush with a mixture of pancreatic enzymes and
bicarbonate
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Components of Parenteral
Nutrition
Dextrose
Amino Acids
Lipid
Electrolytes, vitamins, trace elements
Dextrose
The optimal amount is that which is
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Amino Acids
kcals/gm,
Available in 3%- 20% concentrations
Lipid
Lipid provides essential fatty acids and a calorically-
PPN
A maximum of 900 mOsm/L is recommended
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Complications of Parenteral
Nutrition
Catheter-related Complications
Hepatic Complications
Metabolic Bone Disease (Long
term )
Electrolyte abnormalities
nutrient sources
Essential Fatty Acid, choline or carnitine
deficiency
Bacterial overgrowth (exhibited in rats)
Elevated Manganese levels
An absence of intraluminal nutrients to
Chronic hypercalciuria
chronic acidosis
Al toxicity due to contamination
more common in patients with SBS and IBD
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Electrolyte Abnormalities
Sodium
Potassium
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Gottschlich, MM. The ASPEN Nutrition Support Core Curriculum. A Case- Based
Approach. Silver Spring, MD: ASPEN; 2007
Shikora, S, Martindale R, Schwaitzberg S. Nutritional Consideration in the Intensive
Care Unit. Dubuque, IA: ASPEN; 2002
Merritt R. The ASPEN Nutrition Support Practice Manual. 2nd ed. Silver Spring, MD:
ASPEN; 2005
Meguid MM, Landel AM, TerzJJ, Akrabawi SS. Effect of Elemental Diet on Albumin
and Urea Synthesis: Comparison with Partially Hydrolyzed Protein Diet. J Surg Res
1984; 37 (1):16-24
Albina, J et al: Nitrogen Utilization from Elemental Diets. JPEN 1985; 9(2):189-95
McClave SA, et al. Poor Validity of Residual Volume as a Marker for Risk of
Aspiration in Critically Ill Patients. CCM 2005; 33:324-30
McClave SA, Snider HA. Clinical Use of Gastric Residual Volume as a Monitor for
Patients on Enteral Tube Feeding. JPEN 2002;26(6):S43-48
Keohane PP, Attrill H, Love M, et al.: Relation Between Osmolality of Diet and
Gastroiintestinal Side Effects in Enteral Nutrition. BMJ (Clin Res Ed) 1984:288:67880
Raman M, et al. Metabolic Bone Disease in Patients Receiving Home Parenteral
Nutrition: A Canadian Study and Review JPEN 2006; 30(6):492-6.
Gottschlich MM. The Science and Practice of Nutrition Support. A Core-Based
Curriculm. Silver Sprong, MD:ASPEN; 2001
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