Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Propofol is a lipid-based sedative that provides 1.1 kcal/mL. Because propofol has rapid onset and quick recovery, it is becoming used widely in critical care units. A 15-year-old critically ill pregnant patient received specialized nutrition support concomitantly with propofol infusion for sedation. ⋯ Caloric intakes from propofol averaged 1275 kcal/d (range 445 to 2354 kcal/d) over a 5-day period. Infusion of propofol or any other lipid-based drug must be monitored closely when given in conjunction with enteral or parenteral nutrition to avoid the pitfalls of overfeeding and hypertriglyceridemia. Enteral and parenteral formulas must be manipulated to provide optimal nutrient intakes while not overfeeding with fat when using increased amounts of lipid-based drugs.
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A 43-year-old patient with adult respiratory distress syndrome, alcoholic hallucinosis, and delirium required significant amounts of lorazepam, morphine, and midazolam for management of agitation and increased peak airway pressures. Broad-spectrum antibiotics and intermittent pancuronium therapy were instituted. A nasoenteral feeding tube was placed for nutrition and medication administration during mechanical ventilation. ⋯ A search for drug-related contributing factors to the diarrhea revealed polyethylene glycol present in the lorazepam solution. It was postulated that this could be a contributing cause to the diarrhea. The lorazepam solution was changed to enterally administered crushed tablets with subsequent resolution of diarrhea.
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Clinical and experimental evidence confirms that delivery of nutrients via the gastrointestinal tract reduces septic morbidity in critically injured patients. Early enteral feeding seems to maintain mucosal integrity and to support the gut as an important immunologic organ that may affect other areas of the body. There is increasing evidence to suggest that specific nutrients are especially beneficial in maintaining intestinal host-defense function in times of critical illness and injury.
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Editorial Comment Comparative Study
Shifting ground: enteral vs parenteral nutrition in critically ill patients.