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Nutrition

This outline discusses the nutritional status and requirements for patients, emphasizing the prevalence of malnutrition, including among obese individuals. It evaluates enteral versus parenteral nutrition strategies, highlighting the importance of early enteral feeding for better gastrointestinal protection and potential complications associated with both methods. The document further addresses common issues like constipation and diarrhea, providing management solutions such as prokinetics, bowel management systems, and medications to relieve symptoms. Understanding these aspects is crucial for effective patient care and nutritional support.

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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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