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
