- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Enteral nutrition is a process of being fed with a medical device called a feeding tube. A feeding tube for enteral nutrition is mainly used by patients who have a moderate-to-severe neurological imp...
Enteral nutrition is a process of being fed with a medical device called a feeding tube. A feeding tube for enteral nutrition is mainly used by patients who have a moderate-to-severe neurological impairment that might compromise the swallowing coordination and hence exposes the patients to the risk of aspiration. Clinicians also use enteral feeding in patients with requirements for additional nutritional supplementation. Using a feeding tube to deliver nutrition or supplement to a patient is known as tube feeding, enteral feeding, or gavage. Historical Perspective Parenteral and enteral nutrition dates back to as far 3500 BC to the time of ancient Chinese, Egyptians and Indians. The concept of enteral feeding has existed since the time of Hippocrates, Avicenna and Celsius, and Plato. These ancient physicians prescribed special food for sick patients in the recovery phase of an acute or chronic illness. Around the latter part of the 19th century, the concepts of “dietetics “ was coined. Erasistratus and Herophilus first described the notion of the circulatory system Galen later refined it. Ibn Zur constructed the first model of parenteral nutrition and Capivacceus in the 16th century placed the first tube for enteral nutrition. At the beginning of the 20 century, physicians pondered on the problem of feeding patients incapable of eating either because of protracted illness or its severity. Clouston in 1872 described a method of intragastric feeding that included a cocktail of milk, egg, jelly, and alcohol. In 1882, Bless tried to use the rectal route to deliver nutrition. At the beginning of the 20th century, advances were made in the formulation of mixtures used for enteral feeding. The early and late 50s heralded the start of the space age when cosiderable research on food and nutrition mixtures for astronauts was done. In 1937, Elma was the first person to use hydrolyzed casein as a form of intravenous food for a sick patient. After that, 2 schools of thought developed: Sweden In Sweden, there was a successful infusion intravenously of hydrolyzed casein as a source of protein together with glucose and lipids. They later replaced this with crystalline amino acid as a source of protein. United States of America In Philadelphia, Aubaniac was able to successfully infuse hypertonic glucose and nitrogen via a central venous catheter. Wilmore and Dudrick in 1967 reported a case of successfully providing parenteral nutrition for an infant for 6 weeks. Parenteral nutrition was in vogue until about 25 years ago when enteral nutrition was again gradually reintroduced as the best mode of feeding patient. Enteral nutrition has continued to develop in leaps and bounds because clinicians were able to establish malnutrition as an independent risk factor for mortality. The malnourished patient is more prone to have prolonged hospital, increased the length of stay in the intensive care unit (ICU), more days on mechanical ventilation, prolonged wound healing. and a higher risk of mortality. In the early 80s, chemically-defined and organ-specific diets were developed. Scientists made new advances in the feeding tube. Access to the gut also improved with advances in endoscopic technique and interventional radiology. Wilmore et al. proposed that translocation of bacteria from the gastrointestinal (GI) tract is a major cause of and trigger for sepsis. Current research focuses on looking at the GI tract as an organ with hormonal, immune, and metabolic functions that acts a major barrier to pathogens and intraluminal toxins. Goals of Enteral Nutrition Patients that are critically ill are prone to go into a catabolic state of metabolism. This can cause the breakdown of protein in the body leading to a loss lean body mass. Proteins are the building block of enzymes and hormones in the body. The dis-balance created by the breakdown of protein can cause wound dehiscence in surgical patients or impair the host response to infection. Enteral nutrition serves the following purposes: Provision of adequate micronutrients and macronutrients to meet the metabolic demands of a sick patient. Cut down on nitrogen deficit created by the catabolic state. Avoid complication associated with enteral nutrition. Modulation of the immunological and inflammatory response.
- [Metabolic Acidosis under Acetaminophen Intake - an Unordinary Side Effect]. [Journal Article]
- AIAnasthesiol Intensivmed Notfallmed Schmerzther 2018; 53(10):718-722
- Metabolic acidosis is common among hospitalized patients. However, in a few cases a long-term administration of acetaminophen can lead to transient 5-oxoproline accumulation and causes metabolic acid...
Metabolic acidosis is common among hospitalized patients. However, in a few cases a long-term administration of acetaminophen can lead to transient 5-oxoproline accumulation and causes metabolic acidosis with high anion gap in adults. A 73-year-old man was hospitalized with Staph. aureus sepsis after right knee prosthesis infection and received analgesic treatment with acetaminophen 2 g/d and antibiotic therapy with flucloxacillin over several weeks. The patient had a protracted course of illness and was transferred to intensive care unit with progressing vigilance reduction and for metabolic acidosis with high anion gap. Further medical investigation confirmed an increased concentration of 5-oxoproline in urine. A change in antibiotic treatment, interruption of acetaminophen and administration of acetylcysteine lead to a normalization of the acid-base balance. In a patient with metabolic acidosis under acetaminophen administration, particularly in the context of sepsis, malnutrition, liver and kidney diseases as well as antibiotic treatment with flucloxacillin an accumulation of 5-oxoproline must be considered. The treatment with acetaminophen must be interrupted and acetylcysteine should be administered.
- Nutrition in Pediatric Chronic Liver Disease. [Journal Article]
- PAPediatr Ann 2018 Nov 01; 47(11):e445-e451
- More than one-half of children with chronic liver disease suffer from malnutrition, which leads not only to a poor quality of life and even possibly catastrophic complications, but also to poor outco...
More than one-half of children with chronic liver disease suffer from malnutrition, which leads not only to a poor quality of life and even possibly catastrophic complications, but also to poor outcomes after a liver transplantation. These children have increased metabolic demands but often decreased intake with malabsorption and altered nutrient utilization, all of which make it difficult to keep up with nutritional demands. Assessment of a patient's nutritional status should be timely, and it should be performed routinely and proactively. When specific nutritional needs are identified, these should be addressed with a multidisciplinary team approach and with the close guidance of an experienced pediatric dietician. The assessment includes anthropometric and laboratory assessments, in addition to a careful physical examination and a detailed patient history. The specific nutritional needs vary, but generally dietary intervention focuses on increasing caloric intake, supplementation with medium-chain triglycerides, and prevention of essential fatty acid and fat-soluble vitamin deficiencies. [Pediatr Ann. 2018;47(11):e445-e451.].
- [Pneumonia of the elderly and its link to oral health]. [Journal Article]
- RMRev Med Suisse 2018 Nov 07; 14(626):2007-2011
- Pneumonia is a frequent and serious disease among the elderly, often associated with functional and cognitive impairments, dysphagia, malnutrition and immunosenescence. Although the link between the ...
Pneumonia is a frequent and serious disease among the elderly, often associated with functional and cognitive impairments, dysphagia, malnutrition and immunosenescence. Although the link between the oral hygiene and the risk of pneumonia has been established, the oral status and swallowing function are not routinely screened in the context of a geriatric assessment. Bacteria from oral plaque are regularly aspirated into the lungs and periodontitis induces a chronic inflammation favoring the oral and respiratory epithelial colonization with respiratory pathogens, hence facilitating infections. The poor oral health status and related masticatory impairment are often associated with malnutrition and dehydration. Patients are stranded in a vicious circle of respiratory infections and relapses. Prevention in form of oral health care and daily oral hygiene has proven to be effective.
- Heart Valve Disease Predict Mortality in Hemodiaylsis Patients: A Single Center Experience. [Journal Article]
- TATher Apher Dial 2018 Nov 13
- CONCLUSIONS: Age, coronary artery disease and especially pathology in more than one heart valve are risk factors for mortality. Heart valve problems might developed due to malnutrition and inflammation caused by the chronic renal failure.
- Health Workers' and Villagers' Perceptions of Young Child Health, Growth Monitoring, and the Role of the Health System in Remote Thailand. [Journal Article]
- FNFood Nutr Bull 2018 Nov 12; :379572118808632
- CONCLUSIONS: Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.
- Eculizumab Is Safe and Effective as a Long-term Treatment for Protein-losing Enteropathy Due to CD55 Deficiency. [Journal Article]
- JPJ Pediatr Gastroenterol Nutr 2018 Nov 08
- CONCLUSIONS: CD55-deficiency patients present with early-onset diarrhea, edema, severe hypoalbuminemia, abdominal pain, and malnutrition. Targeted therapy with the terminal complement inhibitor eculizumab has positive clinical and laboratory outcomes in PLE related to CD55 loss-of-function mutations, previously a life-threatening condition. Our results demonstrate the potential of genetic diagnosis to guide tailored treatment, and underscore the significant role of the complement system in the intestine.
- The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation. [Journal Article]
- PTPediatr Transplant 2018 Nov 11; :e13321
- CONCLUSIONS: Children with low BMI prior to transplant and those requiring CIC after transplant are at increased risk for post-transplant FTT. FTT is associated with adverse outcomes, evidenced by increased infections and hospitalizations.
- Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity. [Journal Article]
- BCBladder Cancer 2018 Oct 29; 4(4):377-388
- CONCLUSIONS: Increasing class of obesity and hypoalbuminemia were independently associated with increased complications following RC. Hypoalbuminemia and class III obesity were associated with early mortality. This study highlights the fact that malnutrition may coexist in obese patients and underscores the need to identify patients with malnutrition who may be candidates for preoperative nutritional optimization.
New Search Next
- [Pica]. [Journal Article]
- BNBrain Nerve 2018; 70(11):1173-1180
- Pica is an extremely troublesome behaviors and causes a particularly high burdens for family caregivers. It can lead to dangerous medical consequences, such as malnutrition and intoxication, which so...
Pica is an extremely troublesome behaviors and causes a particularly high burdens for family caregivers. It can lead to dangerous medical consequences, such as malnutrition and intoxication, which sometimes require emergency medical treatment. Its neural basis and underlying mechanisms, however, have not been clarified. We addressed these issues by investigating patients with acquired brain injury who presented with pica. We found that semantic memory deficits were most often associated with pica rather than frontal release signs or changes in eating behaviors. Individuals with pica displayed lesion in the posterior part of the middle temporal gyrus, although spread across a wide area. Taken together, our findings suggest that semantic memory deficits, because of temporal lobe damage might be associated with pica. Moreover, Alzheimer's disease and semantic dementia are the two main degenerative disease etiologies that cause pica. Our findings may also be applied to degenerative disorders as temporal lobe involvement and semantic memory deficits are common. The most common items ingested in pica are daily necessities that are easy to swallow or drink; as such, these items should be avoided in patients with pica.