Enteral nutrition complications

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

Compare clinical efficacy, complications, and costs of enteral nutrition (EN) versus parenteral nutrition (PN). 

Gastrointestinal complications are the most common complications of enteral nutrition (EN), limiting the amount of feeding that patients receive. 

Paling A, Girbes ARJ. Esophageal obstruction an unusual complication of enteral nutrition. Care Crit 111 2000 16 224-5. 

Name three complications of enteral nutritional support therapy. 

Three complications of enteral nutritional support therapy are dehydration, aspiration, and diarrhea. 

Enteral nutrition (EN) decreases septic complications when compared with parenteral nutrition (PN) in severely injured trauma patients. 

Trice S, Melnik G, Page CP. Complications and costs of early postoperative parenteral versus enteral nutrition in trauma patients. Nutr Clin Pract 1997 12 114-119. 

The gastrointestinal (Gl) tract is the optimal route for providing nutrients unless obstruction, severe pancreatitis, or other Gl complications are present (see Fig. 136-1). Other considerations that may have an impact on determination of an appropriate route for nutrition support include expected duration of nutrition therapy and risk of aspiration. Patients who have nonfunctional Gl tracts or are otherwise not candidates for enteral nutrition (EN) may benefit from PN. Use of the intravenous route for nutrition support is also commonly referred to as total parenteral nutrition (TPN) or hyperalimentation. Routine monitoring is necessary to ensure that the nutrition regimen is suitable for a given patient as his or her clinical condition changes and to minimize or treat complications early. 

The gastrointestinal (Gl) tract defends the host from toxins and antigens by both immunologic and nonimmunologic mechanisms, collectively referred to as the gut barrier function. Whenever possible, enteral nutrition (EN) is preferred over parenteral nutrition (PN) because it is as effective, may reduce metabolic and infectious complications, and is less expensive. 

MacLaren R. Intolerance to intragastric enteral nutrition in critically ill patients Complications and management. Pharmacotherapy 2000 20 1486-1498. 

Petrov MS, Van Santvoort HC, Besselink MGH, Van Der Heijden GJMG, Windsor JA, Gooszen HG. Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis a meta-analysis of randomized trials. Arch Surg 2008 143 1111-7. 

Magnuson BL, Clifford TM, Hoskins LA, et al. Enteral nutrition and drug administration, interactions, and complications. Nutr Clin Pract 2005 20 618-624. 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

Nakasaki H, Katayama T, Yokoyama S, Tajima T, Mitomi T, Tsuda M, Suga T, Fujii K. Complication of parenternal nutrition composed of essential amino acids and histidine in adults with renal failure. J Parenter Enteral Nutr 1993 17(l) 86-90. 

Peripheral PN (PPN) is a relatively safe and simple method of nutritional support. PPN candidates do not have large nutritional requirements, are not fluid restricted, and are expected to begin enteral intake within lOto 14days. Thrombophlebitis is a common complication this risk is greater with solution osmolarities greater than 600 to 900 mOsm/L (Table 60-2). Solutions for PPN have lower final concentrations of amino acid (3% to 5%), dextrose (5% to 10%) and micronutrients as compared to central parenteral nutrition (CPN). 

The Hippocratic idea that dyscrasia was the cause of nearly all diseases meant that dietetics (= diaita) was necessary for the restoration to normal of the life order . (s. p. 6) Even in antiquity, special forms of nutrition were of great importance in the treatment of liver diseases. In addition to those dietary prescriptions which were within the reach of everyone (e. g. donkey liver with parsley and honey) (s. pp 7, 844), there were also extremely complicated diets for the treatment of jaundice which only kings could afford (Celsus called jaundice the morbus regius). (s. p. 7) During all historical epochs of medicine, dietetic measures have played an essential role in the treatment of liver diseases - even in the so-called dirty pharmacy of mediaeval times, (s. p. 844) Because dietetics also assumed such an important role in hepatology, nutrition, i.e. enteral intake of special beverages and food, was mainly based on mythological and later also on speculative ideas. 

Janigan DT, Percy B, Marrie TJ, Chiasson PM, Hirsch D. Skin necrosis an unusual complication of hyperphosphatemia during total parenteral nutrition therapy. J Parenter Enteral Nutr 1997 21(l) 50-2. 

Duerksen DR, Ahmad A, Doweiko J, Bistrian BR, Mascioli EA. Risk of symptomatic central venous thrombotic complications in AIDS patients receiving home parenteral nutrition. J Parenter Enteral Nutr 1996 20(4) 302-5. 

Velez RJ, Myers B, Guber MS. Severe acute metabolic acidosis (acute beriberi) an avoidable complication of total parenteral nutrition. J Parenter Enteral Nutr 1985 9 216-9. 

Patients with mild AP can begin oral feeding within several days of the onset of pain. In severe disease, nutritional deficits develop rapidly and are complicated by tissue necrosis, organ failure, and surgery. Enteral or parenteral nutrition should be initiated if it is anticipated that oral nutrition will be withheld for more than 1 week, as nutritional depletion can impair recovery and increase the risk of complications. Although total parenteral nutrition is very effective in critically ill... 

Detsky AS, Baker JP, O Rourke K, et al. Predicting nutrition-associated complications for residents undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr 1987 11 440 46. 

Selection of the enteral feeding formulation depends on nutritional requirements, the patient s primary disease state and related complications, and nutrient digestibility and... 

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