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G48 Gastroenterology
Hypomagnesemia may be an initial sign of short bowel syndrome in patients who have undergone surgical bowel resection
Enteral vs. Parenteral Nutrition for Acute Pancreatitis
Cochrane DB of Syst Rev 2010;1:CD002837 Purpose: Compare EN vs. TPN on mortality, morbidity, and hospital stay in patients with pancreatitis.
Study Selection: RCTs of TPN vs. EN in pancreatitis.
Results: Eight trials (n=348) were included. Enteral nutrition decreases RR of death (0.50), multiple organ failure (0.55), infection (0.39), and other local complications (0.70). It also decreased hospital stay by 2.37 d.
Conclusion: EN reduces mortality, organ failure, infections, and length of hospital stay in patients with pancreatitis.
Clinical Nutrition Toronto Notes 2019 Parenteral Nutrition
Definition
• parenteralnutrition(PN)isthepracticeoffeedingapersonintravenously,bypassingtheusualprocess of eating and digestion
Indications
• short-term(<1mo)
■ whenever GI tract not functioning
■ only situations where PN has been well shown to increase survival are after bone marrow transplant
and in short bowel syndrome, some evidence for benefit in gastric cancer, but often used in ICU,
perioperatively, and in difficult to control sepsis
■ pre-operative: only useful in severely malnourished (e.g. loss of >15% of pre-morbid weight, serum
albumin <28 g/L or <2.8 g/dL), and only if given for ≥2 wk
■ renal failure: PN shown to increase rate of recovery; no increase in survival
■ liver disease: branched chain amino acids may shorten duration of encephalopathy; no increase in
survival
■ IBD: PN closes fistulae and heals acute exacerbations of mucosal inflammation, but effect is
transient (EN is equally effective)
■ some evidence for efficacy, but convincing data not available for:
◆ radiation/chemotherapy-induced enteritis ◆ AIDS with wasting diarrhea
◆ severe acute pancreatitis
• long-term(>1mo):canbegivenathome
■ severe untreatable small bowel disease (e.g. radiation enteritis, extensive CD, high output fistulae) ■ following surgical resection of >70% of small bowel (e.g. small bowel infarction)
■ severe motility diseases (e.g. scleroderma affecting bowel)
Relative Contraindications
• functionalGItractforenteralnutrition
• activeinfection;atleastuntilappropriateantibioticcoverage
• inadequatevenousaccess;triple-lumencentralvenouslinesusuallypreventthisproblem • unreliablepatientorclinicalsetting
Complications of PN
• sepsis:mostseriousofthecommoncomplications
• mechanicalpneumothoraxfrominsertionofcentralline,cathetermigrationandthrombosis,air
embolus
• metabolic: CHF, hyperglycemia, gallstones, cholestasis
Enteral Nutrition vs . Parenteral Nutrition
• fewerseriouscomplications(especiallysepsis)
• nutritionalrequirementsforenterallyadministerednutritionbetterunderstood • cansupplygut-specificfuelssuchasglutamineandshortchainfattyacids
• nutrientsintheintestinallumenpreventatrophyofthegutandpancreas
• preventsgallstonesbystimulatinggallbladdermotility
• muchlessexpensive