1. 1 بسم الله الرحمن الرحيم

2. 2 Complications of Enteral Nutrition Therapy, causes and management Dr Mohammad Safarian

3. 3 Which type of complications? Which type of complications? Who may be at risk? Who may be at risk? Early detection and treatment? Early detection and treatment?

4. 4 Monitoring of EN therapy The main objectives: To ensure about safety, and early detection and treatment of complications To assess the extent to which nutritional objectives have been reached. To alter the type or components of the regimen, to improve its effectiveness and to prevent complications.

5. 5 General considerations Basic clinical observations (temperature, pulse, oedema) Observations of feeding technique and its possible complications Measures of nutritional intake. Weight changes Fluid balance charts (in hospital) Laboratory data Outcome factors (complications, improvements) Change in socio-psychological state which might influence nutritional therapy

6. 6 Monitoring For formula intolerance, For formula intolerance, Hydration status, Hydration status, Electrolyte status, Electrolyte status, Nutritional status, Nutritional status,

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19. 19 High risk of refeeding problems Consider: Consider: starting nutrition support at 10 kcal/kg/day max starting nutrition support at 10 kcal/kg/day max increasing levels slowly to meet or exceed full needs by 4–7 days. using only 5 kcal/kg/day in extreme cases providing immediately before and during the first 10 days of feeding: oral thiamin 200–300 mg daily

20. 20 High risk of refeeding problems Consider: Consider: increasing levels slowly increasing levels slowly restoring circulatory volume and monitoring fluid balance and clinical status restoring circulatory volume and monitoring fluid balance and clinical status providing a multivitamin/trace element supplement providing a multivitamin/trace element supplement providing extra potassium, phosphate and magnesium providing extra potassium, phosphate and magnesium

21. 21 Transition from PN to EN Schedule PN ml/hr EN ml/hr Day1100% Day 2 Decrease by 10-20 20-30 Day3 30-40 Day 4 Decrease by 10-20 40-50 Day5 Stop PN Increase 10ml/hr every 24 hr

22. 22 Thank you