Kyle Dardashti’s Post

WHO ADDED SALINE FLUSHES TO THE TUBE FEEDING OF MY PATIENT??? • Hyponatremia with enteral nutrition occurs when patients receiving tube feeding develop low blood sodium levels due to inadequate sodium in the formula or excessive free water. When you compare the daily intake of sodium from the tube feeding prescribed to your patient vs an oral diet "low in sodium" that typically provides up to 2300 mg sodium daily, you might be surprised to find that most of your patients on tube feedings have intake of sodium way below this number. Have you done the math already? If you haven't, this is why you should: Let's take Nepro and Suplena at a rate of 40 mL/hr (these are formulas and common rates as they are often prescribed for patients with chronic kidney disease): "Low sodium" diet. = 2300 mg Na/day Nepro 40 mL/hr x 24h. = 1008 mg Na/day Suplena 40 mL/hr x 24h = 769 mg Na/day Isotonic (~280-290 mOsm/kg) and hypertonic (>290 mOsm/kg) hyponatremia could be related to inadequate intake of sodium from the enteral formula, just as it could be from inadequate intake from a "low sodium" oral diet. Hypotonic or "dilutional" hyponatremia is suspected at serum osmalility levels <280 mOsm/kg. • Symptoms of hyponatremia include nausea, vomiting, headache, fatigue, confusion, muscle cramps, and seizures in severe cases. This can lead to not meeting nutrient needs for patients due to enteral nutrition infusion interruptions, development of hospital-acquired pressure injuries, longer hospital stays and costs and inability of the patient to participate in rehabilitative therapy, among other outcomes. Vomiting can also worsen existing electrolyte abnormalities turning this into a vicious cycle. • Risk factors for hyponatremia include high-volume enteral feeding, impaired kidney function, and conditions affecting fluid balance. • Management of hyponatremia could include adjusting the enteral formula by increasing sodium content (NaCl tablets or saline flushes), monitoring fluid intake, and regular blood tests to monitor sodium levels. "Management" is the key word here, as there is no point in ordering labs to monitor electrolyte imbalances if you are not going to change a thing you are doing for your patient. That would be the equivalent of having a fireman watch a house burn while holding a fire hose and not doing anything with it to put off the fire. One last math tip... you might want to use these conversion factors to figure out how much you need to supplement with: 1 g NaCl (39.34% Na by wt) = 393.4 mg Na 1000 mL of 0.9% NaCl = 3600 mg Na The attached article highlights the effect of isotonic normal saline versus water in tube feeding for correcting hyponatremia among ICU patients at a tertiary care hospital. #HYPONATREMIA #TUBEFEEDING #ENTERALNUTRITION #NUTRITIONSUPPORT #ELECTROLYTEMANAGEMENT

Isotonic Normal Saline vs. Water in #TubeFeeding: A Comparative Approach to Correcting #Hyponatremia in #ICUPatients

❓Have you ever asked yourself what role nutrition therapy plays in the treatment of chronic pancreatitis? ✅If you have done so, I recommend reading our latest research published just recently. The answer might surprise you. ⬇️ ‼️In this study, we show that malnourished patients with chronic pancreatitis benefit from intensified nutritional therapy. Notably, benefits of a 6-months multimodal intervention exceed improved nutritional status by also reducing parameters of disease severity and thus potentially prognosis. These findings highlight that nutrition therapy is a powerful asset in the management of this progressive and incurable disease.‼️ Thanks to all collaborators who were involved in this project. #EnErGie Universitätsmedizin Greifswald Universitätsmedizin Rostock Hochschule Neubrandenburg

📣 The European Society for Clinical Nutrition and Metabolism has updated its guidelines on clinical nutrition in IBD. Identifying and treating nutrient deficiencies is central to improving quality of life and preventing further complications in patients with IBD. 👉 The new ESPEN guidelines on nutrition in IBD focus on: 1⃣The role of nutrition in the prevention of IBD 2⃣Energy, protein, and micronutrients needs in IBD to avoid malnutrition 3⃣The role of Crohn’s Disease Exclusion Diet in active IBD and alternative interventions if oral feeding isn't sufficient 4⃣Nutritional therapy before and after surgery in IBD 5⃣Where are we on probiotics, prebiotics, and fecal microbiota transplants in IBD 6⃣The role of diet and nutrition in remission of IBD 📚 Catherine Wall, PhD, NZRD, and Andreu Prados, PhD, BPharm, RDN, summarized for you the main ESPEN guideline’s take-home messages on the role of nutritional therapy in the management of IBD: https://loom.ly/8oinL0U

Nutritional therapy is ready to be integrated into the medical management of #Crohnsdisease.   📣 The ECCO European Crohn' and Colitis Organisation has recently released a new update of guidelines on when to use enteral nutrition and food-based diets Here are the most relevant takeaways for your clinical practice: 1⃣ Exclusive enteral nutrition: It involves replacing food with medical nutrition supplement drinks for 6-12 weeks (formula type does not affect efficacy)   🔸 Children: ✅ first choice for inducing clinical remission ✅ superior over corticosteroids for mucosal healing   🔸 Adults (including pregnant women and adults over 65 years): ✅ induction of remission ✅ optimization of outcomes in patients requiring bowel resection surgery ✅ a registered dietitian is vital to improve tolerance However, enteral nutrition is not recommended in: ❌ Perianal disease ❌ Peripheral and axial spondyloarthropathy ❌ Patients who aren’t motivated to follow the formula  ❌ Patients who don’t have access to dietetic support 2⃣ Diet may help in the maintenance of remission of #Crohnsdisease ✅ Partial enteral nutrition, with or without medication ✅ Crohn’s Disease Exclusion Diet (alone or in combination with partial enteral nutrition) ✅ Specific Carbohydrate Diet ✅ Anti-inflammatory diet ✅ Low FODMAP diet is recommended primarily for patients with quiescent CD experiencing functional symptoms We are living in exciting times when it comes to integrating nutritional therapies, an important adjunct and, in some cases, a primary therapy for IBD. 👉 Follow us to find out more about which dietary options exist in IBD and practical insights to understand how they work:

ESPEN guidelines on Nutrition in Inflammatory bowel diseases(IBD): A diet rich in fruit and vegetables, rich in n-3 fatty acids, and low in n-6 fatty acids is associated with a decreased risk of developing IBD. Ultra-processed food and dietary emulsifiers such as carboxymethylcellulose could be associated with an increased risk of IBD. Breastfeeding reduces the risk of IBD. Patients with IBD are at risk and therefore should be screened for malnutrition at the time of diagnosis and thereafter on a regular basis. Documented malnutrition in patients with IBD should be treated appropriately because malnutrition worsens the prognosis, complication rates, mortality, and quality of life.

Do you want to refresh the latest research on the role of nutrition in IBD presented at ECCO 2024? Members of Nutritional Therapy for IBD team attended the conference in person and we want to share with you what the latest research says about which diets fit the disease course of IBD and considerations before implementing them in clinical practice: ✅ When should nutritional interventions be used in the course of IBD (nutrition is not only for malnourished patients!) ✅ What science-based dietary options exist for managing IBS-like symptoms and for improving nutritional status before surgery ✅ How to overcome the tolerance issues of exclusive enteral nutrition that threatens its therapeutic role as induction therapy ✅ Which novel dietary interventions patient-friendly exist for IBD ✅ What is new in the nutritional management of CD ✅ How to improve patient with IBD adherence to diet (tip: comprehensive written and verbal dietary education works better than generalized written advice) 📚 Take a look at these highlights and discussions happening in the field of nutritional therapy for IBD: https://loom.ly/0mIlt7I And stay tuned for the upcoming second part of ECCO'24 nutritional highlights covering what is new in enteral nutrition, the microbiome and dietary supplements in IBD!

For every nutrition support clinician, the 2nd edition of the ASPEN Enteral Nutrition Handbook provides practical tools, techniques, and time-saving tips that are invaluable for all levels of experience in enteral nutrition care. 🔍 What's new in the 2nd edition? ✨ Updated and expanded content featuring evidence-based recommendations  ✨ Practical application guides and hands-on clinical skills  ✨ Comprehensive coverage of the foundational science underpinning enteral nutrition This handbook is designed to empower clinicians with the knowledge and skills needed to deliver the highest quality of care. It's an indispensable resource that combines the latest research with real-world clinical expertise. Grab your copy today: https://bit.ly/3LmzY7l American Society for Parenteral & Enteral Nutrition (ASPEN) [Image Description: Purple and blue logo for “aspen;” and “American Society for Parenteral and Enteral Nutrition.”] #DaretoBeRare #PatientEmpowerment #HealthcareSolutions #PatientSafety #BeAnythingButOrdinary #LifeWithoutLimits #ChallengeWhatsPossible #PatientEmpowerment #DreamBigWithGusGear #GusGearAcrosstheGlobe #EnteralNutrition #ClinicalNutrition 

Carbohydrate and Fiber Intake on Fasting Blood Glucose Levels In Patients with Type 2 Diabetes Mellitus after Intervention of Brown Rice Diet Chyntia Cahyawardani, Etik Sulistyowati, Endang Widajati Abstract Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia that occurs due to a decrease in insulin secretion by pancreatic beta cells and insulin resistance. One of the pillars in the management of T2DM is medical nutrition therapy in the form of a balanced diet. A good intake of carbohydrates and fiber can help control fasting blood glucose levels of diabetic patients. This study aims to determine the relationship between carbohydrate and fiber intake on fasting blood glucose levels in patients with T2DM after the intervention of brown rice diet. The type used in this study was pre-experimental without control variables and the sample was not selected randomly. The design was one-shot case study by looking at the post-test results. The number of samples was 18 people aged 48–60 years. Data analysis used the Shapiro Wilk normality test and Spearman correlation test. The results showed that most of the respondents had normal carbohydrate intake (88.9%) and all respondents had good fiber intake (100%). Most of the respondents had uncontrolled fasting blood glucose levels (55.6%). There is no relationship between carbohydrate and fiber intake on fasting blood glucose levels after the intervention of a brown rice-based diet menu. Keywords: T2DM, Brown Rice, Carbohydrate Intake, Fiber Intake, Fasting Blood Glucose Levels DOI: https://lnkd.in/dxxtRTpW   #IJHN, #HumanNutrition, #FIKESUB

Our latest case report entitled "Successful Weaning from Parenteral Nutrition in a Short Bowel Syndrome Patient with High-Output Stoma through Restricted Oral Diet" was published in the European Journal of Clinical Nutrition. This report explores the critical role of a restricted oral diet, in combination with parenteral nutrition and pharmacological management, in treating a complex case of Short Bowel Syndrome (SBS). We highlight how these interventions led to remarkable improvements in a patient with only 80 cm of remaining bowel and a high-output stoma. 💡Key takeaways: -A tailored restrictive oral diet significantly reduced stoma output and improved the patient’s nutritional status. -High patient compliance and a multidisciplinary approach were essential in achieving successful weaning from parenteral nutrition. -Pharmacological advancements, including the use of Teduglutide, demonstrated promising results in improving intestinal absorption and patient outcomes. 🔗 Read the full paper here: https://lnkd.in/dYyezW5V #ClinicalNutrition #SBS #ShortBowelSyndrome #NutritionManagement #ParenteralNutrition #Teduglutide #Research #Healthcare #PatientCare #CaseReport