Nutrition support

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

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

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

Elemental: broken into smallest forms

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

Polymeric: intact, not broken down (full necklace)

When pt is severely starved or malnourished

Severe electrolyte disturbance

72/24hr

abnormal glucose metabolism

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

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

Liver function tests ALT and AST

Albumin and pre-albumin

BGL's

300mg IV 30 min before feeding

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

In RFS = decrease thiamine which is integral to CHO metabolism

Multivitamin daily 10/7 UNLESS on TPN

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

Monitor and replace electrolytes

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

Medical: past and present; surgery? Chemo?

ondansetron (anti-nausea)

Aperients (relieve constipation)

Esomeprazole (reduces stomach acid)

Vomiting/diarrhoea

Ileus (damaged gut therefore need to bypass-PN)

PICC line

>2 weeks

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

<2 weeks

blood flow 150mL/min

In a lumen ONLY for nutrition purposes

Gut is not functioning

Period of oral nutrition inadequate >1 week

Enteral has been tried but unsuccessful

Severe NIS

Energy: 100-125kJ/Kg/day

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

CHO: 5-10g/Kg/day bw

Fat: 1-1.5g/kg/day

Fluid: 30-35ml/Kg/day

CHECK GLUCOSE INFUSION

ALT & AST increased= overfeeding

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

See back page for monitoring guidelines doc

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

USE UBW if WNR BMI

See requirements for "nutrition prescription" under PN