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Chapter 073. Enteral and Parenteral Nutrition (Part 5)

Disease-Specific Nutritional Support SNS is basically a support therapy and is primary therapy only for the treatment or prevention of malnutrition. Certain conditions require modification of nutritional support because of organ or system impairment. For instance, in nitrogen accumulation disorders, protein intake may need to be reduced. However, in renal disease, except for brief periods of several days, protein intakes should approach requirement levels of at least 0.8 g/kg or higher up to 1.2 g/kg as long as the blood urea nitrogen does not exceed 100 mg/dL. If this is not possible, then dialysis or hemofiltration should be considered to. | Chapter 073. Enteral and Parenteral Nutrition Part 5 Disease-Specific Nutritional Support SNS is basically a support therapy and is primary therapy only for the treatment or prevention of malnutrition. Certain conditions require modification of nutritional support because of organ or system impairment. For instance in nitrogen accumulation disorders protein intake may need to be reduced. However in renal disease except for brief periods of several days protein intakes should approach requirement levels of at least 0.8 g kg or higher up to 1.2 g kg as long as the blood urea nitrogen does not exceed 100 mg dL. If this is not possible then dialysis or hemofiltration should be considered to allow better feeding. In hepatic failure intakes of 1.2-1.4 g kg up to the optimal 1.5 g kg should be attempted as long as encephalopathy due to protein intolerance is not encountered. In the presence of protein intolerance formulas containing 33-50 branched-chain amino acids are available at the 1.2-1.4-g kg level. Cardiac patients and many severely stressed patients often benefit from fluid and sodium restriction to levels of 1000 mL of total parenteral nutrition TPN formula and 5-20 meq of sodium per day. In patients with severe chronic PCM characterized by severe weight loss and tissue wasting TPN must be instituted gradually because of the profound antinatriuresis antidiuresis and intracellular accumulation of potassium magnesium and phosphorus. This is usually accomplished by limiting fluid intakes initially to about 1000 mL containing modest carbohydrate content of 1020 dextrose low sodium and ample potassium magnesium and phosphorus with careful assessment of fluid and electrolyte status. Protein need not be restricted. newpage The Design of Individual Regimens Fluid Requirements The normal daily requirement for fluid is 30 mL kg of body weight from all sources IV infusions per tube or oral intake plus any replacement of abnormal losses such as an osmotic diuresis .