Chapter 073. Enteral and Parenteral Nutrition (Part 12)

Table 73-10 Enteral FormulasComposition CharacteristicsClinical IndicationsSTANDARD ENTERAL FORMULA1. Complete dietary products (+)aSuitableformostpatientsrequiring tube feeding; some can be a. Caloric density 1 kcal/mL used orally b. Protein ~14% cals, caseinates,soy, lactalbuminc. CHO ~60% cals, hydrolyzed corn starch, maltodextrin, sucrosed. Fat ~30% cals, corn, soy, safflower oilse. Recommended daily intake of all minerals and vitamins in 1500 kcal/df. Osmolality (mosmol/kg): ~300MODIFIED ENTERAL FORMULAS1. Caloric density 1.5–2 kcal/mL (+)Fluid-restricted patientsCritically ill patients 2. a. High protein ~20–25% Impaired absorption protein (+) Immune-enhancing diets ...
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Chapter 073. Enteral and Parenteral Nutrition (Part 12) Chapter 073. Enteral and Parenteral Nutrition (Part 12)Table 73-10 Enteral FormulasComposition Characteristics Clinical IndicationsSTANDARD ENTERAL FORMULA1. Complete dietary products (+)a Suitable for most patients requiring tube feeding; some can bea. Caloric density 1 kcal/mL used orallyb. Protein ~14% cals, caseinates,soy, lactalbumin c. CHO ~60% cals, hydrolyzedcorn starch, maltodextrin, sucrose d. Fat ~30% cals, corn, soy,safflower oils e. Recommended daily intake ofall minerals and vitamins in >1500kcal/d f. Osmolality (mosmol/kg): ~300 MODIFIED ENTERAL FORMULAS 1. Caloric density 1.5–2 kcal/mL Fluid-restricted patients(+) Critically ill patients 2. a. High protein ~20–25% Impaired absorptionprotein (+) Immune-enhancing diets b. Hydrolyzed protein to smallpeptides (+) Liver failure patients intolerant of c. Arginine, glutamine, 0.8 g/kg proteinnucleotides, ω3 fat (+++) Renal failure patient for brief d. Branched-chain amino acids, periods if critically illaromatic amino acids (+++) Fat malabsorption e. Low protein of high biologic Pulmonary failure with CO2value retention on standard formula, limited 3. a. Low fat, partial MCT utilitysubstitution (+) Improvement in glycemic index b. Fat >40% cals (++) control in diabetes c. Fat from MUFA (++) Improved ventilation in ARDS d. Fat from ω3 and ω6 linoleic Improved laxationacid (+++) 4. Fiber provided as soypolysaccharide (+) Cost: + inexpensive; ++ moderately expensive; +++ very expensive. Note: ARDS, acute respiratory distress syndrome; CHO, carbohydrate;MCT, medium-chain triglyceride; MUFA, monounsaturated fatty acids; ω3 or ω6,polyunsaturated fat with first double bond at carbon 3 (fish oils) or carbon 6(vegetable oils). Source: Adapted from chapter in Harrisons Principles of InternalMedicine, 16e, by Lyn Howard, MD. Complications Aspiration The debilitated patient with poor gastric emptying and impairment ofswallowing and cough is at risk for aspiration; this is particularly true for thosewho are mechanically ventilated. Tracheal suctioning induces coughing andgastric regurgitation, and cuffs on endotracheal or tracheostomy tubes seldomprotect against aspiration. Preventive measures include elevating the head of thebed to 30 degrees, using nurse-directed algorithms for formula advancement,combining enteral with parenteral feeding, and using post–ligament of Treitzfeeding. Tube feeding should not be discontinued for gastric residuals of bowel feeding, residuals are not assessed but abdominal pain and distention shouldbe monitored.