Section
VII
What
problems can occur and what is the treatment?
|
PROBLEM
|
TREATMENT
|
|
Constipation
(causes)
- inactivity
- decreased
fluids
- lack
of fiber
- antimotility
agent e.g. anticholenergenics
Gastroparesis
(causes)
- antimotility
drug
- injury
induced illness
- chronic
illness
- chronic
illness
- high
fat content of food
Diarrhea
(causes)
- mucosal
atrophy and malabsorption
- increased
irritability
- excessive
osomolar load
- antibiotics
- excess
nutrient delivery
|
- increase hydration
- use of fiber in
enteral formulas
- stool softeners
- laxatives /
discontinue antimotility drugs
- promotility
agents: crythromycin, isapride
- decrease fat
content of nutrients
- adjust osmolarity
to isomolar
- reduce rate of
nutrient delivery
- add antimotility
agent plus fiber or pectin
- rule out C
difficele toxin
- use of low fat
high, peptides solutions
- add glutamine to
nutrient intake
|
| |
|
Despite
being the preferred approach to nutritional support, a number of
gastrointestinal problems can occur with enteral nutrition. Many of
these are caused by a combination of the effects if the injury and
pain medications plus the nutrient itself especially nutrient
supplements with high osmolarity, high fat and low fiber content.
Constipation
may
be due to dehydration especially with the addition of drugs with
anticholinergic activity (e.g. Haldol). Use of hydration, stool
softeners and laxatives are usually sufficient.
Gastroparesis
or impaired gastric emptying is often more difficult to manage as this
process; may be due to the use of necessary drugs e.g. narcotics.
Increased fat will also produce delayed emptying. Effective
promotility agents are now available in addition to lower fat
nutrients.
Diarrhea
is the most common problem due to gut atrophy, antibiotics, hyper
molar feeds and or too much nutrient delivery. Adding glutamine often
can improve gut absorption, Increasing fiber and decreasing nutrient
load will help.
