Enteral Nutrition

Enteral administration is food or drug administration via the human gastrointestinal tract. Parenteral nutrition refers to the delivery of calories and nutrients into a vein. Fundamental goals of nutritional support are- Meet the energy requirements for metabolic purposesTissue repairMaintenance of core temperatureMinimize the protein breakdown and preserve the lean body mass. ENTERAL NUTRITION Indications of enteral nutrition Distal, low output, entrocutaneous fistulaDysphagia except to liquidsPatients after major trauma or surgeryProtein energy malnutrition with poor oral intake Contraindications Severe pancreatitisSevere diarrheaProximal or high output small intestinal fistulaSmall bowel obstruction or ileus AccessNasogastric (Increased risk of aspiration)Nasoduodenal/nasojejunal routePercutaneous endoscopic gastrostomy/jejunostomySurgical gastrostomy/jejunostomy Methods Bolus or gravity method—250 to 500 mL 4–6 hourlyIntermittent—some calculated amount hourlyContinuous infusion—infusion at 20–40 mL/hour of full strength formula. Nasogastric Tube Feeding: Contraindications for nasoesophageal or gastric tube feeding:-unconsciousness or lack of protective laryngeal reflexes.-nasojejunal tubes to bypass dysfunctional gastric stomas and high GI fistulas.By infusion pumps:-decrease incidence of GI side effects induced by overly rapid delivery of hyperosmolar solutions.-allows safer administration of larger daily volumes of nutrients; minimizes gastric distention. Nasogastric tube insertion is also a Skill Station in DNB ENT OSCE - Gastrostomy Tube Feeding: For patients with chronic GI lesions arising at or above the cardioesophageal junction.-contraindicated for mentally obtunded pts with inadequate laryngeal reflexes.-used only in alert patients or in patients with total obstruction of distal esophagus.-feeding mixture may be pureed foods.-hyperosmolarity of the feeding formula is not generally a problem as long as pylorus is intact. Jejunostomy Tube Feeding: For patients in which nasoesophageal or gastrostomy tube feedings are contraindicated:-comatose patients.-patients with high GI fistulas or obstructions.-patients in whom a nasojejunal feeding tube cannot be placed. Enteral nutrition formulas Low residue isotonic formula with 1 kcal/mL is the first line formulaIsotonic formula with dietary fiber (digestible dietary pectins)—delay intestinal transit and decrease the incidence of diarrhea.Immune enhancing formula—formulas containing branched chain amino acids, omega 3 fatty acids.Calorie dense formulas—2 kcal/mL for intragastric feeding.High protein formulas—suitable for trauma/critically ill patients.Elemental formuals—predigested nutrients with high osmolality. Need dilution before administration. Used in patients with malnutrition and pancreatitisRenal failure formula—contain essential amino acids and low volumePulmonary failure formula—high fat content (50%) and low in carbohydratesHepatic failure formula—increased branched chain amino acids. Complications Metabolic complicationsHyperglycemia or hypoglycemiaHypertriglyceridemiaAzotemiaOsteoporosisRefeeding syndrome

Fundamental goals of nutritional support are-

Indications of enteral nutrition

Contraindications

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