Specialized Nutrition Support

Aka: Specialized Nutrition Support, Nutrition Support

1. Evaluation
   1. See Subjective Global Assessment of Nutritional Status
   2. See Lab Markers of Malnutrition
2. Indications
   1. No food intake secondary to underlying condition (adjusted for malnourishment at baseline)
      1. Adults: 5-7 days
      2. Children: 3-5 days
      3. Infants: 1-3 days
   2. Specific conditions
      1. Impaired bowel function (e.g. short bowel syndrome)
      2. Severe prolonged hypercatabolic state
      3. Severe protein-calorie malnutrition (due to a treatable condition)
      4. Prolonged bowel rest (e.g. Inflammatory Bowel Disease exacerbation)
3. Types
   1. Enteral Nutrition
      1. Prefererred form of nutritional support
   2. Peripheral Parenteral Nutrition (PPN)
   3. Total Parenteral Nutrition (TPN)
4. Evaluation: Nutritional requirements
   1. Calories
      1. Adults: 25-35 kcal/kg/day
      2. Child >5 years: 1500 kcal/day for weight of 20kg, then 25 kcal/day per each additional kg above 20 kg
   2. Protein
      1. Adults: 0.8 to 1.5 g/kg/day
      2. All Children and infants, as well as those adults in hypercatabolic or protein losing states require higher protein intake
   3. Linoleic Acid
      1. Dose: 2-4% of total calories should be in this form to prevent essential Fatty Acid deficiency
5. Prcautions
   1. Refeeding Syndrome risk
      1. Start refeeding at one third or less of nutritional needs and gradually increase every 5-7 days
6. References
   1. Kulick (2011) Am Fam Physician 83(2): 173-83