Lab orders to follow tube feedings - Forum

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Pathologist

Lab orders to follow tube feedings - Ärzteforum

Post#1 »

Lab orders are fairly standardized for total parenteral nutrition patients.

Suppose, however, that you have a fairly typical prolonged post-op jejunal (or at least post-pyloric) feeding patient with significant protein calorie malnutrition (albumin 1.8-2.2 for example) probably with gastroparesis. How would you follow them with lab in general?

Would you use a different lab strategy if you tube feedings contained standard amounts of sugar or low amounts (diabetic formulas) or if your tube feedings were double strength (2 cal per cc) or if your patient had diarrhea or high nasogastric tube output?

Obviously, the most correct answer is individualize lab, but I really want to know if anyone has protocols that they order at their hospital, such as a "Tube feeding lab protocol".


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Surgeon

Re: Lab orders to follow tube feedings - Ärzteforum

Post#2 »

I hope I am answering your question. We are very simplistic with enteral feeding, if the patient is very malnourished or unfed in a hypercatabolic situation we start with a semi elemental feed Peptison, for an adult usually about 1L per day. If this is tolerated we increase to 2L and if tolerated change to nutrison usually around 3 - 4 days but it all depends on how well tolerated - i.e. no increased abdo distension and no diarrhoea. Since we started using these products post op care of these patients has improved considerably, as all the mixes are done for us and come in an easy to put up pack. We don't do any calculations and no other special mixes. The philosophy is if you keep it really simple then it will get done. If its any more sophisticated then it will go wrong and therefore be worthless.

Chirurgia

Re: Lab orders to follow tube feedings - Ärzteforum

Post#3 »

The Nutrition Support Service at our institution has come up with the following "enteral lab protocol". Baseline labs: CBC, SMA-12, Mg. Follow-up: electrolytes weekly, SMA-12 every two weeks, Mg each month, and Zn as needed. They do include the disclaimer that "more frequent determinations may be necessary, especially while nutritional repletion is being carried out in an anabolic patient recovering from an illness."

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