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Nutrition

Nutrition. Nov 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

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Nutrition

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  1. Nutrition Nov 2013

  2. Outline • Nutritional status & requirements • Enteral vs parenteral • Complications • Managing problems • Constipation & diarrhoea

  3. 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

  4. 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

  5. Complications Enteral Parenteral NG misplacement Underfeeding Aspiration Loose stools Line related complications Ongoing central access needed Increased infection Abnormal LFT’s Hyperglycaemia

  6. Managing problems • NG vs NJ • Prokinetics • The NG “never event” • Ileus

  7. Constipation • Easy to forget • Senna/lactulose • Glycerine suppositories/phosphate enema • Neostigmine

  8. Diarrhoea • Isolate and send samples • Hand hygiene • Non-infective diarrhoea is common, esp with NG feed • Loperamide • High stoma output • Bowel management systems

  9. Summary • Nutritional needs • NG vs TPN • Troubleshooting • Constipation & diarrhoea

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