Internal Medicine

P1: OXT/OZN/JDO P2: PSB

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

Enteral and Parenteral Nutrition 525

■neurologic disease

➣CVA

➣dysphagia

➣head trauma

➣demyelinating Disease

■gastrointestinal disease

➣short-bowel syndrome (enteral support >100 cm jejunum and

150 cm ileum with ileocecal valve intact)

➣inflammatory bowel disease

➣GI tract fistula output (enteral support: <500 ml/day)

➣pancreatitis (parenteral: abdominal pain, elevated serum amy-

lase or increased pancreatic fistula drainage with oral feedings)

➣esophageal obstruction

■oncologic disease

➣chemotherapy

➣radiotherapy

➣neoplasm

■psychiatric disease

➣anorexia nervosa (parenteral if severe malnutrition and intoler-

ance to enteral feedings)

➣severe depression

■critical care

➣respiratory, renal, cardiac, or hepatic failure

➣parenteral if GI tract nonfunctional or NPO >4 to 5 days

tests

Basic Tests: Blood

■glucose sodium potassium

■albumin/pre-albumin blood urea nitrogen creatinine

■hemaglobin hematocrit total lymphocyte count

■transferrin acetone

Basic Tests: Urine

■24 hour urine urea nitrogen for nitrogen balance

Other Tests:

■height

■weight (actual, usual, ideal)

■weight changes

■chest x-ray

■clinical signs of malnutrition

■intake and output