Malnutrition is a serious threat among medical inpatients and can predict poor outcomes. Nutrition support (nutrient mixtures or artificial feeding) may help treat or prevent malnutrition in these individuals.
Nutritional support will depend on an individual’s symptoms. There are two forms available – enteral nutrition and parenteral nutrition, both administered via tubes into either their stomach or bloodstream.
Enteral Nutrition (EN)
EN may be necessary in cases in which patients cannot swallow normally or their gastrointestinal tract cannot tolerate a regular diet, often in cases related to stroke or amyotrophic lateral sclerosis which affect swallowing function. EN can be administered either continuously or intermittently. Continuous enteral nutrition (EN) is typically recommended for individuals with an intact gag reflex who cannot tolerate fasting regimens; intermittent or “bolus” feedings may be more appropriate in noncritically ill individuals who still possess their gag reflex but cannot manage fasting protocols. Family physicians caring for EN patients must monitor how their formula affects the patient (e.g. emesis/regurgitation, abdominal distention, gastric residuals), so as to not exceed the goal rate and volume of EN prescribed by medical guidelines.
ASPEN/SCCM guidelines suggest withholding EN in patients whose mean arterial pressure falls below 60 mm Hg or who are receiving multiple or increasing doses of vasopressor agents, in addition to aspiration or fluid overload symptoms.
Parenteral Nutrition (PN)
Parenteral nutrition (PN) can be lifesaving for patients who cannot meet their nutritional needs through eating or oral feeding tubes alone. PN can be especially helpful when the gastrointestinal tract becomes impaired due to serious disease, surgery or other circumstances; its contents include carbohydrates, lipids, amino acids, vitamins and trace elements which are administered through either central venous catheter or peripherally inserted catheter.
PN can be prepared by hospital pharmacies with compounding pharmacists, then administered using an IV pump with IV tubing attached. Multi-chamber bags manufactured commercially may also be an option.
PN admixtures should be kept away from direct light to avoid photodegradation of lipids and nutrients, while monitoring of fluid and electrolyte losses must also be conducted regularly for all patients receiving PN therapy.
Nutritional Products
Nutritional products refer to any supplemental vitamins or minerals added to food to increase nutritional value or provide specific vitamins that populations may be deficient in. For instance, flour and bread are often fortified with iron; citrus-fruit beverages contain extra Vitamin C; salt contains iodine for goitre prevention; thiamin riboflavin and niacin are added to rice to combat pellagra (brittle hair). Herbal medicines, vitamins, minerals, homeopathic supplements are often utilized as nutritional support – typically associated with complementary and alternative medicine (CAM).
Nutrition Support Professionals
Patients suffering from severe conditions that prevent them from eating or digesting usually require nutritional support in the form of enteral nutrition (tube feeding) or parenteral nutrition (intravenous tube into vein).
A multidisciplinary team comprised of physicians, pharmacists and nurses specializing in nutrition support works together to provide patients with optimal care based on medical history, laboratory data and dietary needs.
The National Board of Nutrition Support Certification (NBNSC) recently updated their program to better reflect the expertise, knowledge and skills of all health-care professionals managing patients receiving nutrition support therapy – such as dietitians, physician assistants, nurse practitioners and pharmacists who serve in hospitals, homecare agencies and long-term care facilities. Their unified credential, Certified Nutrition Support Clinician (CNSC), has become widely used by these health-care professionals who specialize in managing patient care.
