Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition.

Abstract

the protein bound cobalamin absorption test takes into account the release of cobalamin from protein as well. By doing so it probably shows an earlier and lesser degree of gastric atrophy than that found in pernicious anaemia that is nevertheless sufficient to lead to cobalamin deficiency. Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition P P KEOHANE, HELEN ATTRILL, MARY LOVE, P FROST, D B A SILK Abstract One hundred and eighteen patients with normal gastrointestinal function were randomly allocated to one of three feeding regimens in a double blind study to determine the relation between the tonicity of the diet and gastrointestinal side effects related to the diet and to evaluate the efficacy of "starter" regimens in reducing gastrointestinal side effects during enteral nutrition. Patients received a hypertonic diet with an osmolality of 430 mmol (mosmol)/kg (group 1), the same diet but with the osmolality increasing from 145 to 430 mmol/kg over the first four days (group 2), or an isotonic diet (300 mmol/kg) (group 3). All diets were prepared aseptic- ally and administered by 24 hour nasogastric infusion. The mean daily nitrogen intake in group 1 was significantly greater (p <005) than that in both groups 2 and 3, and the mean overall daily nitrogen balance was significantly better (p <0 05) in group 1 than groups 2 and 3. The incidence of side effects related to the diet was similar in all three groups, but diarrhoea was significantly (p <0 001) associated with concurrent treatment with antibiotics.These findings show that undiluted hypertonic diet results in significantly better nitrogen intake and balance, that starter regimens reduce nutrient intake but not symptoms, and that diarrhoea is significantly related to treatment with antibiotics and not to administration of an undiluted hypertonic polymeric diet.

Lactobacillus GG as Treatment for Diarrhea During Enteral Feeding in Critical Illness

“…Significantly more treatment patients received enteral feeding formula with osmolality >500 mOsm/kg, usually to restrict fluid input. Although it has been suggested that the hyperosmolar formula does not contribute to diarrhea in patients with normal gastrointestinal functioning, 50 it is possible that it could make a difference in critically ill patients.…”

Enteral feeding: techniques of administration.

“…'6 Traditional starter regimens may prevent satisfaction of nutritional demands over the first three to four days of feeding.35 36 Controlled data now available have cast doubt on this practice, there being no difference in the incidence of diarrhoea between a hypotonic starter regimen, an isotonic regimen, and an undiluted hypertonic polymeric diet given by gravity assisted continuous infusion. 35 The final volume of feed required will depend on its energy and nitrogen density, which in turn must be based on water requirements (or restrictions) and nutritional needs.…”

Enteral-feeding-related diarrhoea: proposed causes and possible solutions

“…There is an undisputed association between enteral feeding, antibiotics and diarrhoea Keohane et al 1983Keohane et al , 1984Bastow, 1986;Guenter et al 1990). The incidence of diarrhoea in enterally-fed patients taking antibiotics far exceeds the incidence in normally-fed patients taking the same antibiotics (Keohane et al 1984).…”