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Harrison's Principles of Internal Medicine, 18e
Chapter 76. Enteral and Parenteral Nutrition Therapy
Sections: Enteral and Parenteral Nutrition Therapy: Introduction, The Design of Individual Regimens, Parenteral Nutrition, Enteral Nutrition, Acknowledgment, Further Readings.
Topics Discussed: enteral nutrition; intravenous and parenteral dosage forms; nutrition, digestion, and absorption; nutritional support; parenteral nutrition.
Excerpt:"The ability to provide specialized nutritional support (SNS) represents a major advance in medical therapy. Nutritional support, via either enteral or parenteral routes, is used in two main settings: (1) to provide adequate nutritional intake during the recuperative phase of illness or injury, when the patient's ability to ingest or absorb nutrients is impaired, and (2) to support the patient during the systemic response to inflammation, injury, or infection during an extended critical illness. SNS is also used in patients with permanent loss of intestinal length or function. In addition, an increasing number of elderly patients living in nursing homes and chronic care facilities receive enteral feeding, usually as a consequence of inadequate nutritional intake.Although at least 15–20% of patients in acute care hospitals have evidence of significant malnutrition, only a small fraction will benefit from SNS. For others, wasting is an inevitable component of a terminal disease and the course of the disease will not be altered by SNS. The decision to use SNS should be based on the likelihood that preventing protein-calorie malnutrition (PCM) will increase the likelihood of recovery, reduce infection rates, improve healing, or otherwise shorten the hospital stay...."
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