Indications for parenteral feeding

Patients can be classified according to nutritional (normal or malnourished) and metabolic status.

1. Well-nourished and moderately catabolic (10-15 g urea nitrogen lost daily) patients need therapy if unable to take oral nutrition within 10 days.

2. Well-nourished and severely catabolic (> l5 g urea nitrogen lost daily) patients who are unable to eat need immediate protein-sparing therapy, i.e. anticatabolic support.

3. Malnourished patients (> l0 per cent weight loss in the previous 3 months), particularly if catabolic and with oral intake impossible for more than 5 days, need immediate nutritional support.

Artificial feeding of a well-nourished patient, able to take enteral nutrition within 4 to 5 days or with a relatively minor injury is unnecessary. Parenteral feeding should be performed in the following circumstances.

1. Enteral nutritional support is strictly contraindicated (gut obstruction, high output (i.e. > 0.5 l/h), jejunal or ileal fistula, severe non-hypovolemic gut ischemia, gut failure due to extensive resection or absorption impairment).

2. Enteral nutrition is unable to cope with energy and nutrient requirements (mixed nutrition).

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