Nutrition Support Therapy

Nutrition Support Therapy is an active measure ensuring appropriate intake of energy, nutrients, trace elements and vitamins.

Nutrition Support Therapy Algorithm

 * 1) If intestines are working physiologically, enteral therapy is provided (sipping, nasogastric tube or nasojejunal tube);
 * 2) *if the enteral therapy is indicated for longer period than 4–6 weeks, nutrition is provided via stoma (PEG) with bolus portions, intermittently or continually.
 * 3) In case of intestinal malfunction, parenteral nutrition is indicated (total, accessory);
 * 4) *short-term (up to 10 days) – via peripheral access;
 * 5) *long-term (over 10 days) – via central catheter.
 * 6) Routes of intake:
 * 7) *all-in-one;
 * 8) *multiple bottle.
 * 9) Nutrients in enteral therapy:
 * 10) *carbohydrates – basically glucose (150 g/day);
 * 11) *fat emulsions – 1–2 g/kg/day;
 * 12) *essential amino acids – Val, Leu, Ile, Phe, Try, Lys, Met, Thr.
 * 13) Contraindications:
 * 14) *acute abdomen (ileus), megacolon toxicum, severe abdominal infections, intestinal bleeding;
 * 15) *when fat emulsions are provided, there is a risk of hyperlipoproteinemia, fat embolism, shock, sepsis, DIC.

Dietetics
Dietotherapy stands for diet adjustment that leads to improving the initial patient's disease, so called saving-diet:


 * mechanical saving – diet doesn't increase muscular tonus or peristalsis;
 * chemical saving – diet doesn't irritate the mucosa and doesn't cause hypersecretion;
 * temperature saving – diet doesn't irritate the mucosa with its heat, temperature.

Diet classification

 * 1) strict saving diet – in acute phase, not nutritionally complete;
 * 2) basic saving diet – biologically and nutritionally complete diet, ideal for long-term use;
 * 3) saving diet:
 * 4) *special – tea, fluid nutrition, strictly fat limited, diabetic;
 * 5) *basic – fluid nutrition, mushy, saving, fat limited, intestinal saving diet;
 * 6) *standardized – pancreatitis, lactose intolerance, gluten intolerance, hepatal insufficiency.

Fiber in diet

 * Polycarbohydrate with basically zero energy value.
 * Ideal intake pro die should be 25–30 g (intake over 50 g brings a risk of intestinal obstruction).
 * Fiber diet indicated in all patients who are not required to have a special intestinal saving diet, acts as a prevention against constipation, hemorrhoids, diverticulosis.
 * Soft (water-soluble) fiber – fruit, vegetable, nuts, agar, pectins, slimes – absorbs excessive water from the intestines, swells, also absorbs toxic substances, increases the feces volume a softens it.
 * Raw (non water-soluble) fiber – oats, wooden flowers – cellulose, lignin – increases the feces volume, adjusts peristalsis, constipation prevention.

Související články

 * Parenterální výživa (pediatrie)
 * Biochemické hodnocení výživy
 * Hodnocení výživového stavu
 * Výživová doporučení