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 Enteral nutrition: the provision of nutrients

into the gastrointestinal tract through a tube or catheter when oral intake is inadequate. Also it may include the use of formula as oral supplements or meal replacement.

Principles of Enteral Feeding  Stomach – Principal defense against an enteral osmotic load.Principal area for nutrient absorption.  SI . .  Hyperosmolar solutions invites more complications.

 Gastrostomy  Jejunostomy .Routes for administration of enteral feeding  Nasoenteric and postpyloric feeding.

first osmolality then     volume is increased.An approach to feeding advancement  Position of the patient  For gastric feeding. Feeding started at the @ 10-20mL/hr Gastric volumes checked every 4-6 hrs If less <100-150mL Feeding advanced in 10-20mL increments until the goal is attained. .

volume is increased first then the osmolality ( <300-400mOsm ) Opioids – to slow diarrhea .For SI feeding.

 ↓ infection complications & acute phase protein production .Rationale for enteral nutrition  Low cost  ↓ intestinal mucosal atrophy.

 In whom oral intake is inadequate to restore or maintain optimal nutritional status. who have at least 2-3 ft of functional gastrointestinal tract.Which patient is eligible for nutrition support ? Enteral nutrition  Should be used in Pt.  Who are or will become malnourished. .

transferrin<200mg% Anergy to injected antigens Where there is a functional GI . surgical/ otherwise Serum albumin< 3gm%.General Indications:         The pt’s premorbid state Poor nutritional status… Significant weight loss… Duration of starvation > 7 days Anticipated duration of artificial nutrition >7days The degree of anticipated insult.

ENTERAL FORMULA COMPOSITION Formulas classified in a variety of ways. 10 . usually based on protein or overall macronutrients composition. •General purpose formulas are tolerated by most patients and most of these formulas provide 1 kcal / ml.

immunosuppression. •Disease specific formulas for patients with renal. hepatic or cardiopulmonary disease. metabolic stress. fistulas.5 to 2 kcal / ml are used to restrict fluid for patients with cardiopulmonary.•General formulas that provide 1. sepsis or trauma. •High nitrogen formulas used for patients with burns. renal & hepatic failure. or glucose intolerance. 11 .

Also known as chemically defined. • 30-45 gm protein / L. * 30-40 gm protein / L. • Use in patients with GI compromise. 12 Defined / hydrolyzed (monomeric) Semielemental . Also known as free amino acid formula. • contains free amino acids. * Instituted at full strength . • Provide 1-2 kcal / ml. • provide 1 kcal / ml. * Contain intact protein. * Lactose free. minimal fat and minimal residue. • Lactose free. * Provide 1-2 kcal / ml. 300-500 mOsm / kg. low viscosity. • hyperosmolar and low viscosity. •40 gm protein / L. • Osmolality depends on hydrolysis. (hydrolyzed nutrients to improve digestion). peptide based and elemental formula.ENTERAL FORMULA CATEGORIES General purpose / intact (polymeric) * Use in patients with normal digestion and absorption. • use in patients with limited GI function.

ENTERAL FORMULA CATEGORIES (CONT. fat or carbohydrate as single nutrients to alter the nutrient composition of commercial formulas or food. Modular 13 . • Formula providing protein. • May not nutritionally complete.) Disease specific •Designed for specific organ dysfunction or metabolic disorder. • Most are hyperosmolar. Redehydration • For patient requiring an optimal ratio of simple carbohydrate to electrolytes for the purpose of maximizing fluid and electrolyte absorption and rehydration.

2. Intermittent drip feeding: administered of enteral feeding at specified times throughout the day.ADMINISTRATION The three common methods of tube feeding administration are : 1. 14 . generally in smaller volume and at a slower rate than a bolus feeding but in large volume and faster rate than continuous feeding. Bolus feeding: infusion of up to 5oo ml of enteral formula over 5 to 20 mins by large-bore syringe .

3. Continuous drip feeding: administered of enteral formula into the gastrointestinal tract via pump. 15 . usually over 8 to 24 hours of day.

Products  Complete Formulas  Modular (Supplements)  Elemental  Disease Specific .

K. canola oil. hydrolyzed corn starch. casein  Fat: Soybean oil. carbohydrate and fat  Carbohydrate: Maltodextan. Phos. corn syrup  Protein: Soy protein. MG.Complete formulas  Also called meal replacements  Intact nutrients  One or two sources of protein. Ca & usually trace  With and without fiber . corn oil  Vitamins: RDA in 1250 – 2000 ml  Minerals: Na.

corn syrup . Propac  Fat: MCT oil. Safflower oil  Carbohydrate: Polycose.Modular products  Also called supplements  Provides only one type of nutrient  Given with a complete formula  Protein: ProMod.

Criticare HN  Use: Malabsoption states: Short bowel. pancreatitis . fistula.Elemental formulas  Nutrients broken down  Low fat  MCT oil  Examples: Peptamin.

Disease specific formulas  Hepatic disease  Renal disease  Trauma & stress  Pulmonary disease  Diabetes .

Hepatic disease  Low in aromatic amino acids and methionine  High in branched chained amino acids  Low in amino acid concentration  (High calorie to nitrogen ratio)  Products: Hepatic-Aid II .

Suplena  Low protein. high in essential AA  Modified electrolytes  Caloric dense  Nepro – higher in protein for dialysis patients .Renal disease  Amin-Aid.

Stresstein. AlitraQ  High nitrogen  May be high in BCAA  Caloric dense .Trauma & stress  TraumaCal.

Pulmonary disease  Pulmocare  55% of calories from fat  Primarily corn oil  Intended to decrease CO2 production .

Diabetes  Glucerna  Less carbohydrate  More fat  Intended to improve glucose tolerance .

Monitoring pts receiving nutritional support  Fluid balance record.Protein. daily weighing  Document daily calorie and N intake  RFT. Haematological indices  Regular examination of route of access .Ca.alb. LFT biweekly  Regular check ups for Phos.Mg.

 Mechanical Metabolic Infective- . abd discomfort. nausea. bloating. regurgitation and aspiration of fluids. vomiting.Complications of enteral nutrition  Gastrointestinal – Diarrhea.

Thank You… .