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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 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 • 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
Complications Enteral Parenteral 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