Enteral tube feeds

Diarrhea Drug related Antibiotic-induced bacterial overgrowth Hyperosmolar medications administered via feeding tubes Antacids containing magnesium Malabsorption Hypoalbuminemia/gut mucosal atrophy Pancreatic insufficiency Inadequate GIT surface area Rapid GIT transit Radiation enteritis Tube feeding related Rapid formula administration Formula hyperosmolalty Low residue (fiber) content Lactose intolerance Bacterial contamination... 

A 60-year-old man with type 2 diabetes received radiation therapy for a carcinoma of the esophagus and needed continuous enteric tube feeding (17). One daily injection of glargine controlled his diabetes well his HbAlc concentration was 6.1% and he had no episodes of hypoglycemia for almost 4 months. This made continuous infusion of a short-acting insulin unnecessary. 

Putz D, Kabadi UM. Insulin glargine in continuous enteric tube feeding. Diabetes Care 2002 25(10) 1889-90. 

Dennis MS, Lewis SC, Warlow C et al. (2005). Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD) a multicentre randomised controlled trial. Lancet 365 764-772... 

Hyperemesis gravidarum When enteral tube feeding is not tolerated. 

Dickerson RN. Medication administration considerations for patients receiving enteral tube feedings. Hosp Pharm 2004 39 84-89, 96. 

Before the metabolic toxicity of fructose was appreciated, substitution of fructose for glucose in intravenous solutions, and of fructose for sucrose in enteral tube feeding or diabetic diets, was frequently recommended. 

Ozuna J, Friel P. Effect of enteral tube feeding on serum phenytoin levels. J Neurosurg Nurs (1984) 16,289-91. 

Metabolism Refeeding syndrome is normally associated with large calorie loads delivered by parenteral or enteral feeding. Acute respiratory failure has been attributed to refeeding syndrome induced by hypocaloric enteral tube feeding [81 ]. 

Dickerson RN. Warfarin resistance and enteral tube feeding a vitamin K-indepen-dent interaction. Nutrition 2008 24(10) 1048-52. 

National Institute for Health and Chnical Excellence. Clinical Guideline 32. Nutrition support in adults oral nutrition support, enteral tube feeding and parenteral nutrition. 2006. 

Rakhmanov, R.S. and Gruzdeva, A.E., New balances natural concentrated food product for enteral tube feeding, 7-th Intern. Congress on parenteral and enteral feeding Proceedings, Moscow 2003, pp. 81-82 (in Russian). 

Enteral nutrition (EN) is broadly defined as delivery of nutrients via the gastrointestinal (GI) tract. This could include normal oral feeding as well as delivery of nutrients in a liquid form by a tube. Sometimes when the term enteral nutrition is used, only tube feedings are included hence the terms enteral nutrition and tube feedings are often used synonymously. The bulk of this chapter will include information regarding delivery of feedings via tubes. Formulas for EN usually are delivered in the form of commercially prepared liquid preparations, although some products are produced as powders for reconstitution. 

FIGURE 98-2. Access sites for tube feeding. (From KumpfVJ, Chessman KH. Enteral nutrition. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 

Absorption of antimicrobial agents such as fluoroquinolones and tetracyclines that can be bound by divalent and trivalent cations potentially could be compromised by administration with EN formulas containing these cations. The fluoroquinolones (e.g., levofloxacin and ciprofloxacin) have been best studied in this regard, and results of studies are not consistent. Mechanisms for an interaction between fluoroquinolones and EN formulas other than chelation by cations have been postulated.40 Some institutions hold tube feedings for 30 to 60 minutes or more before and after enteral dosages of fluoroquinolones. Because ciprofloxacin absorption has been shown to be decreased with jejunal administration, this drug probably should not be given by jejunal tube.41... 

Charney P, Russell M. Enteral formulations. In Rolandelli RH, Bankhead R, Boullata JI, Compiler CW, eds. Enteral and Tube Feeding. 4th ed. Philadelphia Elsevier 2005 216-223. 

Heyland DK, Dhaliwal R, Suchner U. Immunonutrition. In Rolandelli RH, Bankhead R, Boullata JI, Compher CW, eds. Enteral and Tube Feeding. 4th ed. Philadelphia Elsevier 2005 224-242. Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients A systematic review of the evidence. JAMA 2001 286 944-953. 

The rapid movement in the global phthalates market away from using plasticisers 2-ethylhexanol (2-EH) and diethylhexyl phthalate (DEHP) in favour of alternative products was underscored recently when BASF revealed plans to close its 2-EH and DEHP plants in Germany. The restructuring in Europe will have no effect on BASF s plasticiser portfolio in Nafta and Asia, however, where the company will continue to offer 2-EH and DEHP. About 70% of the plasticiser maiket volume is phthalates, and plasticisers make up about 60% of the plastic additives maiket. PVC accounts for 80-90% of global plasticiser consumption. In October 2003, California added DEHP to the state s list of more than 750 chemicals known to cause birth defects or reproductive harm. Previous studies had shown that the chemical can leach from plastic bags that contain intravenous fluids, blood, tube feedings or other medical treatment, and thereby enter the bodies of patients. 

Borel, P., Armand, M., Pasquier, B., Senft, M., Dutot, G., Melin, C., Lafont, H., and Lairon, D. (1994). Digestion and absorption of tube-feeding emulsions with different droplet sizes and compositions in the rat. J. Parenter. Enteral. Nutr. 18, 534-543. 

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