Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

526 Enteral and Parenteral Nutrition

differential diagnosis

n/a

management

General Measures

■calories

➣measureed BEE (using metabolic cart)

➣calculated:

using Harris-Benedict equation:

men: (5×Ht cm)+(13.8×Wt kg) – (6.8×age)+66.5

women: (1.8×Ht cm)+(9.6×Wt kg) – (4.7×age)+66.5

➣>30 – 35 kcal/kg body weight or adjusted weight if morbidly obese

(BMI >30 mg/k2)

➣add stress factors 1.2–1.5 for wound healing, fever, sepsis

■protein

➣0.9–1.2 gm/kg (stable)

➣1.2–1.5 gm/kg (critically ill)

➣2–2.5 gm/kg (burns, trauma, sepsis)

■carbohydrate

➣starting at 50% total calories, parenteral dextrose 4–5 mg/kg/

minute

■fluid

➣30–35 ml/kg dry weight; 1 ml/kcal

■fats

➣>20% total calories, < 4% total calories prevents EFA deficiency

■vitamins/minerals

➣100% RDA

■electrolytes

➣based on needs

specific therapy

Treatment Options

■enteral access

➣nasogastric

intact gag reflex

normal gastric motility and outlet

<6 weeks duration

inexpensive

➣nasoduodenal or nasojejunal

GERD/aspiration risks reduced

impaired gastric emptying

less nosocomial pneumonias