Enteral Feeding

Question 1

What is enteral feeding? When is it needed?

Answer 1

refers to intake of food directly into the gastrointestinal (GI) tract.

when a person
- cannot eat any or enough food due to illness, decreased appetite, difficulty swallowing or surgery/obstruction that interferes with eating

Question 2

What are the benefits of enteral feed?

Answer 2

preserves immune response, GI microflora and visceral blood flow

cost benefits

eliminates parenteral nutrition associated complications

Question 3

What is the malnutrition universal screening tool?

Answer 3

a tool that assess the nutrition state of a person and finds their overall risk of malnutrition

it looks at
- BMI, % of unplanned weight loss, acute disease effect score

Question 4

What is gastric motor function?

Answer 4

accommodation and storage of ingested meal
grinding down of solid particles
emptying of meal constituents in a controlled and regulated fashion into the duodenum (small intestine)

Question 5

What is gastroparesis?

Answer 5

gastroparesis/delayed gastric emptying

• a disorder that slows or stops the movement of food from your stomach to your small intestine despite there being no blockage
• affects the normal spontaneous movement of the muscles (motility) in your stomach (paralysis)

Question 6

What medications can cause gastroparesis?

Answer 6

opioid analgesics - codeine
anticholinergic agents - hyoscine butyl bromide
tricyclic antidepressants - amitriptyline
calcium channel blockers - diltiazem
progesterone
aluminium hydroxide antacids
alcohol
tobacco/nicotine

Question 7

What are the factors affecting suitability of liquid formulations given enterally?

Answer 7

pH
osmolality
viscosity
sorbitol content

Question 8

What are the factors affecting drug and formulation given enterally?

Answer 8

GI side effects of drugs
- gastroparesis

tube blockage

pharmacokinetics

Question 9

What factors cause tube blockage?

Answer 9

bore size of the tube

food
- inadequate flushing

drug related
- inappropriate formulations

physical interactions
- sucralfate (complex of aluminium hydroxide and sulfated sucrose)
= aluminium binds to protein to form an insoluble complex

Question 10

What medications can cause increased gastric emptying?

Answer 10

metoclopramide
erythromycin
cisapride

Question 11

What drug interactions can occur with feed?

Answer 11

phenytoin - enteral feed reduces drug absorption
theophylline - interaction is poorly defined and very variable

warfarin - binds to protein in enteral feed which reduced absorption

ciprofloxacin - binds to divalent ions which reduces absorption

tetracyclines - milk and dairy products reduced their absorption

rifampicin - absorption is reduced by food, should be given during a break in feed to maximise absorption

Question 12

What are the issues associated with enteral nutrition initiation and delivery?

Answer 12

referring syndrome
electrolytes need to be monitored and replaced as needed
thiamine and multivitamins need to be replaced
persistent nausea and vomiting can occur
diarrhoea
poor glucose control

Question 13

What is refeeding syndrome?

Answer 13

increased nutrition following a prolonged period of starvation can result in refeeding syndrome

during starvation
- blood glucose levels are low and as a result, cellular metabolism slows down considerably.

after feeding
- glucose levels increase rapidly and a large amount of insulin is released to push the glucose into the cells
- causes a demand for phosphate and other electrolytes in the cells and results in sudden electrolyte shifts
= leading to hypophosphatemia, hypokalaemia, and hypomagnesemia
- there is a shift of sodium out of the cell, as potassium is pumped back into cells via the sodium-potassium pump
= sodium concentrations increase, leading to fluid retention.
- thiamine deficiency occurs
= due to increased metabolic needs in which it is a co-factor