Nutrition - Part 3 - Parenteral nutrition, complications, refeeding syndrome
This is the third part of our nutrition basics series for practical nutrition prescription orders in surgical residency as well as for practical surgical exams like USMLE and MRCS as well as MRCP.
Nutrition basics 2 - Nutrition in the colon and rectal disease as well as enhanced recovery protocols for nutrition - https://www.youtube.com/watch?v=aAaY-...
Prescribing nutrition on rounds - Clinical approach - https://www.youtube.com/watch?v=s--ko...
Nutritional assessment of surgical patient - https://www.youtube.com/watch?v=yxe-b...
Parenteral nutrition is indicated during contraindication to Enteral Nutrition:- Intractable vomiting/ diarrhea refractory to medical management, intestinal obstruction or ileus, high output intestinal fistula, Hemodynamic instability, Intestinal ischemia, Diffuse peritonitis, Severe GI hemorrhage and Severe GI malabsorption.
Two key points for parenteral nutrition are
- - Give only when required for more than 5-7 days minimum
- - Correct the fluid, electrolyte, and acid-base balance first.
Complications of nutrition can be of two types
- - Access route related complications
- - Nutritional therapy-related complications
Both of these are also discussed.
The risk population for refeeding syndrome includes Low BMI, increased unintentional weight loss, and very low nutrient intake in the recent past. The reinstitution of feeding at a very rapid rate in these patients leads to internalization of potassium, phosphorus and magnesium resulting in Hypokalemia, hypomagnesemia, and hypophosphatemia. it can also result in congestive cardiac failure, cardiac arrhythmias, and sudden death if not treated early and appropriately.
Key conclusions from this nutrition basics series are
- - Diet orders are the most important orders
- - Use gut whenever possible
- - TPN needs to be given for a minimum of 7 days to have a beneficial effect
- - Refeeding syndrome should be prevented
- - Management of access devices is important