Magazine article Drug Topics

Home Enteral Nutrition Methods, Information Warrant Attention

Magazine article Drug Topics

Home Enteral Nutrition Methods, Information Warrant Attention

Article excerpt

"We've come a long way since the beef broth and whisky enemas" that kept President Garfield alive for 79 days after an assassination attempt a century ago, Gail Rosen told an attentive audience at the NARD Rx Expo midyear meeting in Reno. Rosen is a pharmacist in the University of Maryland Medical System. "But there remains at least as much art as science in tube feeding," she cautioned.

Enteral nutrition is a promising market for at least the next decade. That was the good news. "About 50 percent of home care services address nutritional problems," she said "It's a growing area that is going to need a lot of our attention."

The bad news is that there are relatively few practical guidelines in the field. Even basic nutritional requirements are open to question. The FDA's Recommended Daily Allowances of nutrients are designed to prevent deficits, not maintain health. There are no RDAs in important areas such as fat intake, although other sources recommend limiting fat to 30 percent or less of total caloric intake.

RDAs are also based on the needs of a population under 51 years of age, not the elderly that make up the lion's share of the home care market. And as if that weren't bad enough, published RDAs assume these are healthy patients, not the borderline to severely ill who typically receive home or long-term care.

Rosen has found that patients generally respond better to short term intubation. The shorter the term, the less likely it is that swallowing and gag reflexes will disappear. Once the gag reflex disappears, the patient has no defense against aspiration of the feeding fluid. "This," she pointed out, "is often a fatal event."

If the gag reflex is intact and other conditions permit, patients should be fed into the stomach. The stomach tolerates bolus feeding, accepts a wider range of formulas, and automatically deals with osmolarity imbalance and other problems.

Patients on tube feeding for four weeks or less can use nasal tubes. Beyond four weeks, they generally need a more permanent arrangement. The safest and most practical setup for many patients is a percutaneous endoscopic gastrostomy, or PEG. …

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