Ch 11: Enteral Nutrition Formulations

Question 1

What is ASPENs stance on high fat/low CHO formulas in respiratory failure?

Answer 1

ASPEN does not recommend the use of a high fat/low CHO formula containing high levels of omega 6 FA

Question 2

What type of patients are semi elemental/elemental formulas intended for?

Answer 2

GI dysfunction, SBS, malabsorption, or pancreatic exocrine insufficiency

Question 3

What is HMB, and what are its benefits?

Answer 3

HMB (metabolite of BCAA leucine) is a dietary supplement that results in positive patient outcomes when provided with or without arginine and glutamine.

HMB promotes anabolism by increasing protein synthesis and inhibiting the ubiquitin proteasome pathway controlling protein degradation thereby conserving and even promoting accretion of LBM

Question 4

When should concentrated formulas be used?

Answer 4

acute respiratory failure b/c the presence of concomitant fluid overload, pulmonary edema, and renal failure are associated w/ worse clinical outcomes. May also be appropriate with liver and heart failure, hypervolemic hyponatremia, decreased UOP, early satiety, and elevated nutrition needs.

Question 5

What type of formula should be considered in patients with DM?

Answer 5

Standard EN formulas used in conjunction w/ appropriate energy provision and insulin therapy are promoted for patients with DM or stressed induced hyperglycemia.

Question 6

What is ASPENs stance of the use of renal specific formulas in patients with an AKI or CKD?

Answer 6

ASPEN recommends standard high protein EN formula for patients with an AKI

Question 7

Intact proteins require normal levels of what for for digestion/absorption.

Answer 7

Pancreatic Enzymes

Question 8

What EN formula should not be used in hepatic failure?

Answer 8

Those with BCAA or “low protein” formulas

Question 9

What is EN considered by the FDA?

Answer 9

EN is considered a “medical food” by the FDA and can make structure/function claims without the approval of the FDA

Question 10

In patients with sepsis, guidelines suggest that _____ % of energy needs to provide in the first week of EN; EN should then be advanced to provide more than 80% of needs after the first week

Answer 10

In patients with sepsis, guidelines suggest that 60-70% of energy needs to provide in the first week of EN; EN should then be advanced to provide more than 80% of needs after the first week

Question 11

In which case may a fiber free formula be safer?

Answer 11

In critically ill patients at risk for gut dysmotility or bowel ischemia

Question 12

What allergens may EN contain?

Answer 12

Milk, corn, soy or eggs. Most are GF and lactose free.

Question 13

What is the respiratory quotient?

Answer 13

RQ is a value that describes C02 production in relation to oxygen consumption.

RQ for CHO = 1.0, protein= 0.8, and lipid= 0.7

Question 14

Most enteral formulas provide adequate amounts of vitamins/minerals to meet DRIs when provided in volumes of what?

Answer 14

1000-1500 mL/d

Question 15

What is hypertonic EN?

Answer 15

“Hypertonic” EN is considered > 320 mOsm/kg, and have frequently been blamed for formula intolerance/diarrhea

Question 16

What macro-nutrient should be provided for all patients and is associated with more positive outcomes?

Answer 16

Protein

Question 17

Which oils are included in commercial enteral formulas to provide a good source of linoleic and α-linolenic acids?

Answer 17

Corn, soybean, safflower, and canola.

Corn, soybean, and safflower oils are rich in linoleic acid.

Soybean and canola oil are good sources of α-linolenic acids.

Question 18

Hospital-prepared enteral nutrition formulas should be stored at approximately what temperature?

Answer 18

4° C (39° F)

Question 19

The bioavailability of which medications may be alerted with EN administration?

Answer 19

The bioavailability of warfarin, phenytoin, carbamazepine, and fluoroquinolones, such as ciprofloxacin, may be altered with enteral nutrition and the enteral feeding is often held for up to two hours before and after administration to reduce interactions