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Hi All!
59M LTC resident, PMH: Acute respiratory failure, spastic quadriplegic cerebral palsy, SIRS.
Weight in 2019 was around 105-108 lb x 7 months. Dropped down to 100 lb, TF increased.
Remained around 100lb x 10 months, dropped to 95-97 lb. Remains at 95-97 lb for around 5 months.
Now weighing 91-93 lb. Height 60 inch, BMI 17.8.
Tubefeed has been increased a few times during this time.
CBC/TSH/CMP/Vit D completed twice this past year, last done in February, unremarkable.
Current regimen: Jevity 1.5 @ 65 mL/hr x 24 hr, FWF 180 mL Q4H. Provides: 2340 calories (57 cal/kg), 2266 mL water (55 mL/kg), 100 g protein (2.5 g/kg)
He is now underweight, very thin/frail. What course of action would you recommend?
Full-text: sci-hub.se/10.1002/14651858.CD006122.pub3
n = 93
Plain language summary
>Patients with severe burn injuries have increased metabolic needs. For this and other reasons, they are often fed a formula through a tube inserted directly into the stomach or small intestine, a process known as enteral feeding. Aggressive enteral feeding of burn patients with a high‐protein diet is a core component of the treatment of severe burn injuries. However, the optimal proportions of fats and carbohydrates in feeding formulas are unknown. This review of 93 burn patients in two randomized controlled trials found that high‐carbohydrate, high‐protein, low‐fat enteral feeds reduced incidence of pneumonia compared with low‐carbohydrate, high‐protein, high‐fat enteral feeds in patients hospitalized with severe burn injuries. No conclusions could be made about the effect of different enteral feeding regimens on death.
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>The strength of this review's findings were limited by the number, size, and quality of eligible trials. Further research is needed before strong scientific conclusions and sound clinical recommendations can be made.
This paper has a unique layout.
Every Christmas, we wish them happy holidays, but this year... One answered back.
So I’ve play Doom external for 48 hour now and I still don’t get one aspect about it. I understand the main point, to refill on ammo but how the fuck can I sometimes chainsaw aracnotrons and the meatballs!? Do you have to have the fuel thing all the way full or is it a chance thing? Anyway if you see this please supply me with your wisdom.
Because i try to keep things interesting, i often enter puns into chat at the beginning of games to get a rise out of some players. The posts are as follows:
- Eichenwalde if i want to, Eichen leave my friends behind.
- Idk about you guys, but i'm sure Havana great time!
- Hey man, you're cruisin for a Busan.
- Ayutthaya? then you better take a nap!
- I hope it's a nacho cheese Dorado, i'm not a fan of the cool ranch.
- Come to Ilios to escape your feelios (usually paired with "More like Fighthouse am i right?" or "Well well well, what have we here?")
- Gibralter, hardly knew her!
Ass, pussy, mouth or other, reply in the comments.
I'm doing the enteral diet right now and haven't taken Remicade even though my doc is saying to do so. Currently have inflammation in colon and small bowel but very few symptoms. I understand it could get worse and there's "silent chrohns" and that the scientific community believes I should go on biologics for life. However there are personal/anecdotal stories I've read where some people are the exception and went into remission with diet etc and no meds. It's just weird cause my only symptoms now are bloating and lots of gas ha. Any info greatly appreciate.
its just my opinion i could never get into doom enteral
So I was just thinking about this and many many other questions that I have about how Dietetics is practiced on other countries.
I’m from Central America and I’m a Dietetics student about to finish my degree. I did my clinical internship at the most important hospital of the country. My family is planning to move to the US and maybe just maybe I will also move to study my MSc in the US or Canada.
I always tried to get information from the Academy, ASPEN, ESPEN, FELANPE, etc. to do our job at the hospital. Can you imagine there’s not even a protocol on what in the world we must do in hospitals once we get to our internship? I was so amazed at this that I couldn’t believe I did 4 years of university education to end up in a place where NOBODY had an idea why I was there.
So, I’ve always been very passionate about everything I do. I can’t handle things that are done poorly. So I designed a proposal on what a Dietetics student must do and accomplish on their internship at least on the hospital we were working on. Yes, it’s THAT badddd! A student doing the job of an adult.
I tried to standardized everything I could and propose work protocols. And i tried to gather as much evidence I could to inform what was our role, why we do what we do and how we could accomplish that in our hospital.
Did you know there is not ONE SINGLE dietitian working inpatient on the most important hospital of the country?! There is SO MUCH need that I wish I could do more but it is so overwhelming.
SO, going back to my question and after giving you guys a bit of my background and why my internship was so frustrating but so enriching at the same time, do you guys from rich countries also do enteral calculations? 😹 what I mean is this:
So we have available basic enteral formulas. We DO NOT have special formulas. We do calculations of nutrition requirements and “modulate” feedings depending on what we need. We use powdered milk, cornstarch, Karo syrup, coconut oil, Proteinex powder, and other ingredients to modulate the diets.
When I go to Abott’s webpage for example, i see so many options we don’t ever have available here. What if you need an isocaloric diet, you must modulate it. If you want it high protein, you must add it. If you want it lower carbohydrates, you must modulate it, and so on and so on.
We must experiment with the formulas available and different ingredients to achieve what the patient needs. So I was wondering if this is something done only here or is
... keep reading on reddit ➡Hi everyone! I’ve been back and forth TPN and enteral (Kate Farms) through the J tube. Right now I’m solely on TPN bc my motility sucks and my J button leaks bile. However, tpn is causing a funky liver and kidneys and my dieting can’t go past 1300 (which I need a LOT more to gain weight. I’m basically being given the option to get off it like now or go to the hospital (which I hate). Anyone have advice or experience with this?
I work in long term care so I do not write TF very often. I have a resident on a continuous formula who is at goal but has been having loose stools. I would like to switch her from osmolite to Jevity. I estimate that switching from no fiber to fiber could cause GI distress under any diet if there isn’t a taper up. How would you proceed?
Hi guys! I know that ASPEN guidelines recommend a goal of 15-20kcal/kg BW for critically ill vented covid-19 patients. Just been wondering if this is the goal for kcal requirements Or is this just a goal for the acute phase of the critical illness or like week 1 of ICU stay. If it is only a week 1/acute phase recommendation when do you increase the goal and to how much (kcal/kg Based on patients for BMI <30).Thanks in advance!
