Fluids, Electrolytes, Acid-Base Disorders, and Nutrition Support

Product Category

Indication

Macronutrients

Additional

Comments

Examples

Increased protein

needs

Critically ill patients

(especially trauma,

surgical, burns)

1 kcal/mL

Protein 62 g/L

High-protein content,

fiber, isotonic

Replete, Promote

Glucose intolerance

Hyperglycemia,

diabetes

1.2 kcal/mL

Protein 60 g/L

Low-carbohydrate

content, fiber

Diabetisource

AC, Glucerna 1.2

Immune enhancing

Critically ill surgical

and trauma patients,

perioperative GI cancer

1.5 kcal/mL

Protein 90–94 g/L

Additional arginine,

glutamine; fish oil

Impact Peptide

1.5, Pivot

Bariatric

Patients with obesity

with good renal

function

1 kcal/mL

Protein 93 g/L

High protein, low

calories

Peptamen Intense

VHP

Elemental

Malabsorption, fat

intolerance

1–1.5 kcal/mL

Protein 50–68 g/L

Low fat/MCT, di/tri-

peptides/free AA, no

fiber, low residue

Vivonex RTF,

Vital

Protein supplement

High protein needs

10–15 g of protein

per serving is typical

(products vary)

Protein liquid, gel, or

powder

Pro-Stat, ProMod

AA = amino acids; MCT = medium-chain triglycerides.

Enteral nutrition – Medication interactions: Hold EN 1 hour before and after drug administration.

*Increase EN rate to account for time off EN.

Phenytoin (Nutr Clin Pract 1996;11:28-31)

Levothyroxine (J Endocrinol Invest 2014;37:583-7; Nutr Clin Pract 2010;25:646-52) - In one study,

liquid levothyroxine preparation was shown to alleviate need to hold EN. In lieu of holding EN,

increasing the levothyroxine dose by 25 mcg per day with weekly monitoring of thyroid function

tests has also been described. Care should be taken to reduce the dose back to the patient’s home

dose when they are transitioned off of EN if this option is chosen.

Fluoroquinolones (J Antimicrob Chemother 1996;38:871-6)

*Some clinicians have empirically increased the dosage of these drugs while giving continuous

enteral feeding rather than holding the EN for 1 hour before and after drug administration. With

the exception of levothyroxine, this author discourages this practice, especially for warfarin and

phenytoin, because the doses necessary to overcome the effects of drug binding to the continuous

EN are potentially toxic when the EN is held or discontinued without a dose adjustment. Others

have increased the ciprofloxacin dose to 750 mg twice daily during continuous EN to achieve

therapeutic plasma concentrations well above the MIC (minimum inhibitory concentration) for a

gram-negative urinary tract infection (J Antimicrob Chemother 1996;38:871-6).