What should all patients be screened for once admitted to hospital?
Malnutrition
Following screening on admission what is created for the patient amongst the MDT and dietitian?
Care Plan - then discussed with the patient and consent gained for any NG tube feeds or parenteral nutrition
Which 3 groups is it usually necessary to provide nutritional support for?
- All severely malnourished patients on admission
- Mod malnourished patients who because of their illness are not expected to eat for >5days
- Normally nourished patients not expected to eat for >5 days or expected to eat <50% normal intake for 8-10 days
Which feeding method is preferred in a patient with a functioning GI tract?
Enteral (via oesophagus, stomach, small or large intestine) rather than parenteral (intravenous)
In re-feeding syndrome, shifts in what can be life-threatening during enteral and parenteral nutrition?
Water and electrolytes
Carbohydrate stimulates insulin release which leads to a cellular uptake of what three things?
Potassium, phosphate and magnesium
Complications in re-feeding syndrome include?
hypophosphataemia, hypokalaemia, hypomagnesaemia and fluid overload due to sodium retention (decreased renal excretion of Na+ and H2O)
What biochemical abnormalities can occur during re-feeding syndrome?
Cardiac arrhythmias and respiratory insufficiency
Patients who have eaten little or nothing for >5days should initially receive no more than ___% of their energy requirements?
50% (NICE guidelines)
Patients at risk of re-feeding syndrome should be given what three things?
- High potency vitamins dailys for 10 days
- Oral or enteral thiamine 50mg 4 times daily for 10 days
- Multivitamins
What are the typical daily fluid requirements?
2-3L daily
What conditions would require reductions in daily fluid requirements?
Oedema, hepatic (liver failure), renal failure and brain oedema
What conditions would require increased daily fluid requirements?
Large-output fistulae (ulcers/sores), nasogastric aspiration (feeding stomach via NGT & draining contents via suction), diarrhoea, fever
What are the typical daily protein requirements per day?
9-15gN/day (0.94-1.56g/kg/d)
Extra protein may be required in severely catabolic conditions such as?
Burns, sepsis and major trauma
What are the typical sodium and potassium daily requirements?
60-100mmol day
In what condition would sodium and potassium requirements increase?
In those with increased GI liquid waste
Requirements of sodium and potassium may be lowered in those suffering which conditions?
Hypernatraemia and hyperkalaemia
The requirements for calcium and magnesium are higher in enteral than parenteral nutrition because?
Only a proportion of these elements is absorbed in the gut
Which vitamin is usually absent from parenteral feeds and may need to be administered seperately?
Vitamin K
What are the 4 reasons many vitamins are given in higher quantities in parenteral compared to enteral nutrition?
- Patients on parenteral nutrition may have increased requirements
- Severe disease
- They may already have depleted vitamin pools
- Some vitamins degrade during storage
What are the 4 routes in which enteral nutrition feeds can be given?
- Via mouth (food supplemented with solid or liquid supplements with multiple benefits)
- By fine-bore nasogastric tube
- By percutaneous endoscopic gastrostomy (PEG) - those needing enteral nutrition >30 days - a catheter is placed percutaneously into the stomach under endoscopic control
- Needly catheter jejunostomy - fine catheter is inserted into the jejunum and brought out through the stomach wall
What are the 4 main complications of NGtubes?
- Regurgitation and aspiration into bronchus
- Blockage of the NG tube
- GI side effects - diarrhoea
- Metabolic complications e.g. hyperglycaemia, hypokalaemia and low levels of magnesium, calcium and phosphate
What is a polymeric diet?
Intact nutrients that are more palatable and cheaper than semi-elemental diets
