Management of intestinal failure

Question 1

What is a clinical application for glutamine?

Answer 1

Not present in conventional TPN
Relatively low levels in many enteral feedings
Mat preserve gut function. Decreased atrophy and reduced translocation
Potential application - bone marrow transplant, short bowel syndrome, intestinal transplant, major surgery, critical illness, mucositis and others

Question 2

What are the complications for intestinal transplants?

Answer 2

Postoperative hemorrhage
Biliary complications - leak or stricture
Vascular complications - thrombosis or obstruction
GI complications - leak, hemorrhage, hypermotility
Allograft rejection -
Graft vs host disease
Infection - leading cause of morbidity/mortality
Recurrent disease - rare
Graft loss and re-transplantation - rejection, ischemia/bleeding and sepsis

Question 3

MNT for patients with a colon who have intestinal failure

Answer 3

5-6 meals per day 
Complex cho 50-60%
Limit simple sugars
Protein 20-30%
Low fat 20-30%
Restrict oxalate
Supplement Ca
Low lactose

Question 4

What is the MNT for patients without a colon who have intestinal failure?

Answer 4

4-6 meals per day
Complex CHO 40-50%
Limit simple sugars
Protein 20-30%
Fat as tolerated
No oxalate restriction
Rehydration solutions (high Na, isotonic, CHO)
No lactose restriction