Nutrition support

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由Marcos Morata

Nutrition support

Diet

See requirements for "nutrition prescription" under PN

USE UBW if WNR BMI

Parenteral Nutrition (PN) bypass the gut

Only gradual increase for re-feeding otherwise DON"T delay

MONITORING

See back page for monitoring guidelines doc

GGT &ALP raised = Cholestasis- cyclic feed to give liver a break

ALT & AST increased= overfeeding

CHECK GLUCOSE INFUSION

Nutrition prescription

Fluid: 30-35ml/Kg/day

Fat: 1-1.5g/kg/day

CHO: 5-10g/Kg/day bw

Protein: 1.0-1.5g/Kg/day OR 1.5-2.0g critically ill

Energy: 100-125kJ/Kg/day

WHEN?

Severe NIS

Enteral has been tried but unsuccessful

Period of oral nutrition inadequate >1 week

Gut is not functioning

Type

Peripherally (PPN)

In a lumen ONLY for nutrition purposes

blood flow 150mL/min

<2 weeks

Centrally (TPN)

Can't use if there is already a picc line for something else

>2 weeks

PICC line

Client hx

NIS/NFPF

Ileus (damaged gut therefore need to bypass-PN)

Vomiting/diarrhoea

Medications past and current:

Esomeprazole (reduces stomach acid)

Aperients (relieve constipation)

ondansetron (anti-nausea)

Medical: past and present; surgery? Chemo?

Monitoring and evaluation

once risk of RFS resolved- trial soft diet HEHP & continue ONS

Monitor and replace electrolytes

If PN remains to reach nutritional adequace, increase TPN to lower range of goal

Re-feeding syndrome (RFS)

Multivitamin daily 10/7 UNLESS on TPN

Thiamine (B1)

In RFS = decrease thiamine which is integral to CHO metabolism

200-300mg IV or 100mg TDS PO 3/7 THEN 100mg PO 7/7

300mg IV 30 min before feeding

BGL's

Albumin and pre-albumin

Liver function tests ALT and AST

RISK of RFS

TWO or more of: BMI<18.5, excessive EtOH, unintentional wt loss >10% 3-6/12

ONE or more: BMI <16, unintentional wt loss >15% <3-6/12, <500kj/24hr or NO intake >10/7

abnormal glucose metabolism

72/24hr

Severe electrolyte disturbance

When pt is severely starved or malnourished

Specialised feeds

Polymeric: intact, not broken down (full necklace)

Semi-elemental: in pairs (partially pre-digested)

Elemental: broken into smallest forms

PERT (pancreatic enzyme replacement therapy)

- trophic feed; small vol of enteral feeding to stimulate the gut

Biochem

K+, Mg, PO4 - nausea and vomiting may cause a decline in these

Anthro:

SGA- check BMI and wt loss % within 3-6/12