Chapter 073. Enteral and Parenteral Nutrition (Part 13) pptx

Chapter 073. Enteral and
Parenteral Nutrition
(Part 13)

Diarrhea
Enteral feeding often leads to diarrhea, especially if bowel function is
compromised by disease or drugs, particularly broad-spectrum antibiotics.
Diarrhea may be controlled by the use of a continuous drip, with a fiber-containing
formula, or by adding an antidiarrheal agent to the formula. However, Clostridium
difficile, which is a common cause of diarrhea in patients being tube fed, should be
ruled out before using antidiarrheal agents. H2 blockers may also assist in
reducing the net fluid presented to the colon. Diarrhea associated with enteral
feeding does not necessarily imply inadequate absorption of nutrients other than
water and electrolytes. Amino acids and glucose are particularly well absorbed in
the upper small bowel except in the most diseased or shortest bowel. Since luminal
nutrients exert trophic effects on the gut mucosa, it is often appropriate to persist
with tube feeding, despite the diarrhea, even when this necessitates supplemental
parenteral fluid support.

Acknowledgment
The authors acknowledge the contributions of Lyn Howard, MD, the author
in earlier editions of HPIM, to material in this chapter

Further Readings
August D et al: Evidence-based approach to optimal manag
ement of HPEN
access. J Parenter Enteral Nutr 30:S5, 2006
Bistrian B, McCowen K: Nutritional support in the adult intensive care
unit: Key controversies. Crit Care Med 34:1525, 2006 [PMID: 16557154]
Centers for Disease Control and Prevention: Reduction in central line–
associated bloodstream infections among patients in intensive care units—

Pennsylvania, April 2001–March 2005. MMWR 54:1013, 2005
Debaveye Y, Van den Berghe G: Risks and benefits of nutritional support
during critical illness. Annu Rev Nutr 26:513, 2006 [PMID: 16848718]
Koretz RL et al: Does enteral nutrition affect clinical outcome? A
systematic review of the randomized trials. Am J Gastroenterol 102(2):412, 2007
[PMID: 17311654]
Milne A et al: Meta-analysis: Protein and energy supple
mentation in older
people. Ann Intern Med 144:37, 2006 [PMID: 16389253]
Plank LD, Hill GL: Energy balance in critical illness. Proc Nutr Soc
62:545, 2003 [PMID: 14506903]
Simpson F, Doig GS: Parenteral vs. enteral nutrition in the critically ill
patient: A meta-
analysis of trials using the intention to treat principle. Intensive
Care Med 31:12, 2005 [PMID: 15592814]
van den Berghe G
et al: Intensive insulin therapy in the critically ill
patients. N Engl J Med 345:1359, 2001