Enteral nutrition case study

Drug/Food interactions Several case reports and single-dose studies suggest that enteral nutritional therapy may decrease phenytoin concentrations however, this has not been substantiated. 

A number of early case reports described warfarin resistance in patients taking enteral feeds that contained high levels of added vitamin Kx- These products were then reformulated to contain lower amounts of vitamin Kx, commonly now about 4 to 10 micrograms per 100 mL however, some cases of interactions have still been reported, and one study in children reported that those receiving enteral nutrition (mostly vitamin K enriched formula) required 2.4-fold higher maintenance warfarin doses. Lipid emulsions containing soya oil might contain sufBcient natural vitamin Kx to alter warfarin requirements. Parenteral multivitamin preparations may also contain vitamin Kx. 

In a prospective study of enteral-based nutritional support regimen in bums and tramna patients, those receiving the highest amoxmts of enteral calories within the first week had the highest incidence of ventilator-assisted pneumonia and the lowest incidence of bacteraemia. PN was associated with a significantly increased risk of bacteraemia (OR=2.5 95% Cl 1.8-3.5), ventilator-assisted pneumonia (OR=2.5 95% Cl 1.7-3.3), and death (OR=1.9 95% Cl 1.1-3.1) [104 ]. A retrospective review of 12 cases of multiple sclerosis patients on home PN showed that there was no improvement in their fxmctional status there were also no significant changes in liver enzymes and bilirubin [105 ]. Five of the patients died within two years form causes unrelated to parenteral nutrition. 

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