NutritionNov 2013

Outline Nutritional status & requirements

Enteral vs parenteral

Complications

Managing problems

Constipation & diarrhoea

Nutritional status & requirements Many patients malnourished on presentation

This includes obese patients

If not malnourished can we wait? Short predicted stay?

Aim for 20-25 kcal/kg/day

Catabolism high protein diet up to 2g/kg/day

Enteral vs parenteral Not a conclusively settled argument

Probably early enteral with a switch to parenteral if fails and not a clear short stay patient CALORIES trial

EN is simpler with benefit of gastrointestinal protection and fewer complications but if it isn’t working properly you are starving the patient

Mortality increases if too large a calorie debt accumulates

Enteral Parenteral

Complications

NG misplacement

Underfeeding

Aspiration

Loose stools

Line related complications Ongoing central access

needed

Increased infection

Abnormal LFT’s

Hyperglycaemia

Managing problems NG vs NJ

Prokinetics

The NG “never event”

Ileus

Constipation Easy to forget

Senna/lactulose

Glycerine suppositories/phosphate enema

Neostigmine

Diarrhoea Isolate and send samples

Hand hygiene

Non-infective diarrhoea is common, esp with NG feed Loperamide

High stoma output

Bowel management systems

Summary Nutritional needs

NG vs TPN

Troubleshooting

Constipation & diarrhoea