Adequate enteral nutritional support is often limited by gastrointestinal (GI) side effects. In this pilot clinical trial we compared an enteral nutrition formula based on soy hydrolysate (study formula, SF) against a widely used intact casein formula (control formula, CF) for the incidence of GI side effects in a completely randomized double blind design. Twenty-three nonsurgical hospitalized patients requiring enteral nutritional support and free of GI symptoms were randomly assigned to receive either the CF or the SF for 6 days continuously. Both formulas were isotonic, low in residue, lactose free and isocaloric, but differed in the type and concentration of protein and the concentration of medium-chain triglycerides. After randomization both groups were comparable in demographic characteristics, and nutritional status, but there were more patients on antibiotics in the CF group. The amount of formula infused per day and the route of administration were equivalent. The number of bowel movements per day was 1.0 +/- 0.5 for the CF group and 0.6 +/- 0.3 for the SF group (p less than 0.05). The incidence of diarrhea was 10.8% days for the CF group and 6.2% for the SF group (p = NS). High gastric residuals occurred in 16.9% of days in the CF group and 3.3% in the SF group (p less than 0.05). Vomiting incidence was 10.8% in the CF group and 1.5% in the SF group (p less than 0.05). After adjustment for the use of antibiotics as a covariate, the differences in number of bowel movements, vomiting and incidence of high residuals became less significant (p less than 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)
A 55‐year‐old male with squamous cell carcinoma of the left mandible, who was treated with chemotherapy, surgery, and radiation, received enteral hyperalimentation for 83 of his 102‐day hospital stay. The hospital course was complicated by fluid and electrolyte imbalance, sepsis, gastric outlet obstruction, and ileus. A modular system of individual nutrient components was used to prepare enteral formulations during 62 of the 83 days of enteral hyperalimentation. The 10 enteral prescription modifications involved both macro‐ and micronutrients, and could not easily have been prepared using standard enteral products. Enteral formula modifications resulted in extended use of the gastrointestinal tract for nutritional support. Continued use of the gastrointestinal tract instead of the intravenous route resulted in a net savings of $4380. The use of modular enteral hyperalimentation may be indicated when the gastrointestinal tract is functional, but when frequent formula manipulation is desired. Modular enteral hyperalimentation can be adapted easily for use by nutrition support teams in acute care settings.
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