Complex Enteral Nutrition

Question 1

What are the three different types of Specialised Feeds?

Answer 1

Elemental: Broken down into the simplest form, easy to digest

Semi-elemental: partially pre-digested but not fully pre-digested

Polymeric: intact, not yet broken down. Additional work by the digestive system

Question 2

What is PN?

Answer 2

Parenteral Nutrition:

The infusion of an intravenous
nutrition formula into the bloodstream

Centrally- TPN
-Pick Line

Question 3

Why would you use PN?

Answer 3

Critically ill AND/OR compromised gastrointestinal tract

Unable to reach adequacy orally OR via enteral routes

The period of inadequate oral AND/OR enteral nutrition is >5/7

Enteral nutrition unsuccessful

Question 4

What are the energy requirements of patient with PN?

Answer 4

Energy:

100-125kJ/kg/day

Overweight use adjusted body weight = (actual body weight – ideal body weight) 0.25 + ideal body weight

Protein:

1.0-1.5g/kg/day OR 1.5-2.0g/kg/day if critically ill

Carbohydrate:

(5-10g/kg/day) body weight

Fat:

1-1.5g/kg/day

Fluid:

30-35mL/kg/day

Question 5

What is refeeding syndrome?

Answer 5

Severe electrolyte disturbances and fluid shifts (including phosphate [PO43-], potassium [K+], magnesium [Mg] and sodium[Na+])

Poor oral intake for 72 / 24hr

Abnormal glucose metabolism

Micronutrient deficiencies (especially thiamine)

Prolonged starvation

Question 6

What is the criteria for a patient to be have High Risk of Refeeding Syndrome?

Answer 6

High risk:

Patient with one or more of the following features:

BMI <16kg/m2
Unintentional Wt loss of >15% <3-6/12 
Very litte (<500kJ/24hr) OR no nutrient intake (i.e. fasting, IV therapy) for >10/7 
Electrolyte derangement 

Patient with two or more of the following features:

BMI <18.5kg/m2
Unintentional Wt loss of >10% <3-6/12
Very litte (est <500kJ/24hr) for >5/ 7 OR evidence of stress/ nutrition depletion
Excessive EtOH

Question 7

What is the criteria for a patient to be have Extremely High Risk of Refeeding Syndrome?

Answer 7

Extremely High Risk:

Patient with one or more of the following features:
BMI <14kg/m2

Negligable intake >15/7 (est <500kJ/24hr) OR no nutrient intake (i.e.

Question 8

What is the possible PESS Statement ?

Answer 8

Severe malnutrition and inadequate PO intake for requirements related to nausea+, vomiting+, anorexia as evidenced by 1/12 10kg (16.6%) LOW, moderate muscle wastage & subcutaneous fat loss, and diet Hx indicating days of minimal to nil intake pre admission.

Question 9

What is a possible intervention Plan?

Answer 9

TT agree to commence Pt on TPN – PICC line insitu

Commence feeding at 6000kJ/day or 100% requirements, whichever is less

Request team re-check electrolytes and replace pre: commencement of TPN

Request a stat dose of 300mg IV Thiamine at least 30mins before feeding