Enteral and Parenteral Nutrition Support PDF

DR NEFISA H. ELBANNA PROF. OF CLINICAL NUTRITION PH D. FROM UNIV OF ILLINOIS USA HOME ECONOMICS HELLWAN UNIVERSITY  ENTERAL AND PARENTERAL NUTRITION SUPPORT  DIETARY SUPPLEMENTATION DIETARY SUPPLEMENTATION Dietary supplementation have been defined As " a product that is i...

DR NEFISA H. ELBANNA PROF. OF CLINICAL NUTRITION PH D. FROM UNIV OF ILLINOIS USA HOME ECONOMICS HELLWAN UNIVERSITY  ENTERAL AND PARENTERAL NUTRITION SUPPORT  DIETARY SUPPLEMENTATION DIETARY SUPPLEMENTATION Dietary supplementation have been defined As " a product that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients  a vitamin, a mineral, a herb or an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients.“  Dietary supplement are intended for ingestion in pill, capsule, tablet or liquid form and are not to be represented for use as a conventional food or as the sole item of a meal or diet. Dietary supplements should be labeled as a " dietary supplement " and carry the dietary supplement facts label. Potential plants including leaves flowers stems and roots that are used for medicinal purposes are formulated in a wide variety of forms including teas infusions and concentrated beverage made from boiling plant root  ENTERAL AND PARENTERAL NUTRITION SUPPORT : Enteral nutrition refers to the provision of nutrition into the gastrointestinal tract through a tube or catheter when oral intake is inadequate. Parenteral nutrition is the provision of nutrients intravenously Parenteral nutrition should be used in patients who are or will become malnourished and who do not have sufficient gastrointestinal function to be able to restore or maintain optimal nutritional status.  When a patient has been determined to be a candidate for enteral nutrition, the appropriate route of access for tube placement is selected  Enteral access selection depends on several factors; factors 1 anticipated length of time enteral feeding will be required, 2 degree of risk for aspiration or tube displacement 3 presence or absence of normal digestion and absorption , 4 whether or not there is a planned surgical intervention ,, 5 administration issues such as formula viscosity and volume.  NASOGASTRIC ROUTE : For short term enteral nutrition of up to 3 or 4 weeks , Nasogastric tube passed through the nose into the stomach is appropriate. Patients with normal gastrointestinal function tolerate this method.  NASOGASTRIC ROUTE : Feeding can be administered by bolus injection or intermittent or continuous infusions. NASODUODENAL OR NASOJEJUNAL They are used for short term enteral nutrition support of up to 3 to 4 weeks In patients with gastric motility disorders, esophageal reflux, or persistent nausea and vomiting, PERCUTANEOUS ENDOSCOPIC GASTROSTOMY OR JEJUNOSTOMY It is a nonsurgical technique for placing a tube directly into the stomach through the abdominal wall, performed using an endoscope and with the patient under local anesthesia. The PEG is the preferred access route for patients requiring tube feeding for more than 3 to 4 weeks. FORMULA COMPOSITION : A wide variety of enteral feeding products are commercially available. The suitability of a feeding formula for a patient should be evaluated based on the following characteristics:  Functional status of the patient‘s gastrointestinal Physical characteristics of the formula such as osmolarity and viscosity Energy and nutrient cotent Digestion and absorption capability of the patient  Other clinical considerations of the patient such as fluid and electrolyte status and organ/ system function and Cost effectiveness Most patients with a variety of clinical conditions tolerate standard formulas intended to meet the nutritional requirements of general patient populations. The formulas are lactose free, contain 1kcal/ml.  PROTEIN: Standard formulas contain biologically complete, intact proteins such as caseinate, lactalbumin, beef, and soy protein isolate  CARBOHYDRATES: The percentage of total calories provided as carbohydrates in enteral formulas varies from 30% to 90%,. The sources in formulas are pureed fruits and vegetables, maltodextrins, sucrose, fructose, and glucose.  LIPID : Lipid provides 1.5% to 55% of the total kilocalories but most formulas have between 30% and 40% of their total kilocalories provided by lipids VITAMINS, MINERALS, AND ELECTROLYTES Most but not all available formulas are designed to meet the dietary reference intakes (DRIs) for vitamins and minerals if a sufficient volume is taken.  PARENTERAL NUTRITION : It is the provision of nutrients directly in the blood. It is an appropriate candidate for parenteral nutrition, it is then necessary to choose between central and peripheral access. Central access refers to catheter tip placement in a large, high- blood-flow vein such as the superior vena cava; this is central parenteral nutrition (CPN). Peripheral access refers to catheter tip placement in a small vein typically in the arm.  I NUTRITION SOLUTIONS Protein Commercially available standard solutions are composed of all the essential amino acids and only some of the nonessential ciystaeine amino acids. Carbohydrates Carbohydrates are supplied as dextrose monohydrate in concentrations ranging from 5% to 7% and should not exceed 5 mg/kg/min. Lipid Lipid emulsions , available in 10 % and 20% concentrations , are composed of aqueous suspensions of soybean or safflower oil. Fluid Fluid needs for parenteral and enteral nutrition are calculated similarly.