Re: Patient not tolerating bolus feedings

[Guest guest]

Two thoughts: Glucerna 1.2 or 1.5, Compleat which is made from real foods and

has 32 gm carbs/ 8 oz can.

Ro

From: Sunny

Sent: Monday, April 25, 2011 10:25 AM

To: rd-usa

Subject: Patient not tolerating bolus feedings

I have a patient that came in on continuous feedings. Tried to increase his

feeding hourly rate to meet his nutrient needs. Continuous rate tolerated

45ml/hr. Anything more there is residuals and diarrhea. Weight is steady x over1

month. He came in on Nestle formula (his preference)Diabetisource AC. Switched

to Ross Glucerna continuous feedings OK without complications. He is being

discharged tomorrow and wanted bolus feedings. Tried 1 can (240ml) every 4 hours

- diarrhea resulted. tried 1/2 can (125ml) same thing.

He goes out on day pass and pureed his own formula (water and vegetables) and

administered same amount (240ml) bolus and stated no complications resulted.

Question: Has anyone had a similar experience? Any suggestions/advice would be

appreciated.He doesn't want to go back to continuous feedings.

Sunny Shahinian

mailto:sunny.shahinian%40yahoo.com

[Guest guest]

Two thoughts: Glucerna 1.2 or 1.5, Compleat which is made from real foods and

has 32 gm carbs/ 8 oz can.

Ro

From: Sunny

Sent: Monday, April 25, 2011 10:25 AM

To: rd-usa

Subject: Patient not tolerating bolus feedings

I have a patient that came in on continuous feedings. Tried to increase his

feeding hourly rate to meet his nutrient needs. Continuous rate tolerated

45ml/hr. Anything more there is residuals and diarrhea. Weight is steady x over1

month. He came in on Nestle formula (his preference)Diabetisource AC. Switched

to Ross Glucerna continuous feedings OK without complications. He is being

discharged tomorrow and wanted bolus feedings. Tried 1 can (240ml) every 4 hours

- diarrhea resulted. tried 1/2 can (125ml) same thing.

He goes out on day pass and pureed his own formula (water and vegetables) and

administered same amount (240ml) bolus and stated no complications resulted.

Question: Has anyone had a similar experience? Any suggestions/advice would be

appreciated.He doesn't want to go back to continuous feedings.

Sunny Shahinian

mailto:sunny.shahinian%40yahoo.com

[Guest guest]

How many mL is the gastric residue?

Is he doing already any prokinetic drug? That would help gastric motility and to

reduce the residue.

How many times he has per day liquid stools? It can only be considered diarrhea

when it is more than 3 times.

The 1st formula he did (nestle Diabetic Source)was administrated in continues

rate or bolus? If it was in bolus do both formulas have the same osmolarity?

I don't know US formulas of the products but you could try to give him one with

low osmolarity. Also soluble fiber is very good to control diarrhea.

If he has high gastric residue the diahrrea probably is caused by reaction to

high osmolarity product since the gastric empting is impaired.

Cátia Borges

>

> I have a patient that came in on continuous feedings. Tried to increase his

feeding hourly rate to meet his nutrient needs. Continuous rate tolerated

45ml/hr. Anything more there is residuals and diarrhea. Weight is steady x over1

month. He came in on Nestle formula (his preference)Diabetisource AC. Switched

to Ross Glucerna continuous feedings OK without complications. He is being

discharged tomorrow and wanted bolus feedings. Tried 1 can (240ml) every 4 hours

- diarrhea resulted. tried 1/2 can (125ml) same thing.

>

> He goes out on day pass and pureed his own formula (water and vegetables) and

administered same amount (240ml) bolus and stated no complications resulted.

>

> Question: Has anyone had a similar experience? Any suggestions/advice would be

appreciated.He doesn't want to go back to continuous feedings.

>

> Sunny Shahinian

> sunny.shahinian@...

>