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Nutrition - Coggle Diagram
Nutrition
Requirements
Total energy requirements
Indirect calorimetry
Harris- Benedict Index
Estimation on IBW
25-30kcal/kg/day
Protein
Nitrogen balance
Open abdomen = loss of protein/nitrogen
1.2-1.5g/kg/day
Energy
Carbohydrate 60%
4kcal
Lipid 40%
9kcal
Protein
4kcal
Electrolytes
Water =30ml
Sodium 1-2mmol
K 0.8-1.2
Calcium, Mg =0.1
Ph = 0.4
Management
Enteral
within 24-48 hours
Prokinetics
Erythromycin
Metocloperimide
Post pyloric
Parenteral
EPaNIC = later start improved survival
ASPEN guideline initiate if <60% 7-10days
energy
protein
Glycaemic control
NICE-SUGAR = worse survival with tight control
Aim 6-10
Re-feeding syndrome
Pabrinex
Re-feeding syndrome
Definition
reinstituition of nutrition
Patients that have been starved
Pathophysiology
Starved state
Protein catabolism
Low total body phosphate
Anabolic state
Insulin release
Glycogen, fat and protein synthesis
Uptake fo phophate into cells
Clinical features
Electrolyte derangement
<Ph
<Ca
< Mg
CVS
Arrythmias
CCF
Neurological
Ataxia
Korsakoffs/wernikes
Risk factors
BMI <16
Unintentional weight loss >15%
Minimal intake >10 days
History of alcohol / drug abuse
Types
Enteral
Advantages
Physiological
Cheaper
No central line
Maintains GI integrity
Reduces bacterial translocation
Promotes immune function
Disadvantages
Diarrhoea
NG tube malposition
VAP risk factor
Sinusitis
Dependent on functioning GI tract
Parenteral
Advantages
Does not require functional GI tract
No delay in caloric intake
Fewer interuptions
Disadvanatges
Non-physiological
Central access
Bactereamia
Expensive
Hypercholesteraemia
Lipid emulsion can cause intrahepatic cholestasis