Complications of Enteral Nutrition 2

Question 1

1. Water is needed to support an individual’s lean body mass. True or false?
2. What is the problem with using the equation 1ml per kcal to estimate fluid needs?
3. Very muscular and active individuals require more water that what is provided in the provided formulas.
   True or false?

Answer 1

1. True
2. The equation 1ml/kcal to estimate fluid needs is inaccurate because it underestimates fluid need.
3. True

Question 2

For obese individuals, the AIBW is used to calculate kcal/pro/fluid needs, what is the other method use to calculate these needs? What other populations can this method be used with?

Answer 2

For obese and chronically inactive individuals, both calories and fluid needs can be calculated by using the IBW alone and adjusting appropriately over time, based on response and observed needs.

Question 3

What is the appropriate formula to calculate fluid needs?

Answer 3

Equation 1
Adults age 18-55: 35ml per kg body weight
Adults age 55-75: 30ml per kg body weight
Adults age >75 years: 25ml per kg body weight
Fluids restriction: ≤ 25ml/kg body weight (renal and cardiac disease, fluid overload states)
Equation 2
1500ml for the 1st 20kg
+ 20ml per kg ≤ age 50
+ 15ml per kg > age 50
Additional fluids should be provided for patients with conditions that result in fluid losses like severe diarrhea etc.

Question 4

In dehydration, which laboratories are affected? How are they affected?

Answer 4

In dehydration, BUN, plasma osmolality and hematocrit is usually elevated whereas Na could elevated, low or normal depending on the etiology of the dehydration.

Question 5

How should we evaluate BUN/Cr ratio?

Answer 5

BUN/Cr ratio should be evaluated in the context of the patient’s nutritional state, as well as underlying renal function.
Pt with low muscle mass will have an artificially, and sometimes extremely, low creatinine.
BUN reflects protein intake as well as state of hydration and renal function.

Question 6

If a patient misses a feeding, what should be done to prevent dehydration?

Answer 6

The fluid content of that feeding should be replaced. If the replacement of fluid is large and cannot be provided via the GI tract, the clinician then may need to consider intravenous fluid therapy.

Question 7

What are possible causes of hypokalemia in enteral fed patients?

Answer 7

• Renal, hepatic or cardiac insufficiency
• Refeeding syndrome
• Catabolic stress
• Depleted cell body mass
• Effect of ADH and aldosterone
• Diuretic therapy
• Excessive losses (diarrhea, nasogastric tube)
• Metabolic alkalosis (induced or result)
• Insulin therapy
• Dilution

Question 8

What are some prevention or therapy for hypokalemia?

Answer 8

• Diuretic therapy (e.g. spironolactone)
• Supplement K to normal before initiation of TF (e.g in referring syndrome)
• Monitor serum K daily until stable with patient at a goal TF rate
• Consider supplemental protocol

Question 9

What are some possible causes of hyperkalemia?

Answer 9

• Metabolic acidosis
• Poor perfusion (e.g. congestive heart failure)
• Renal failure
• Excessive potassium intake from TF, IV fluid, oral intake

Question 10

What are some preventions or therapy for hyperkalemia?

Answer 10

• Correct acidosis, if possible; recheck serum K
• Correct serum K before initiation of TF, if possible
• Monitor serum K daily
• Treat cause of poor perfusion
• Potassium binding resin, glucose, and/or insulin therapy.
• Eliminate K from IV fluid; reduce K in T.F and oral diet