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Enteral feeding and diarrhoea in critically ill patients
F07
ENTERAL FEEDINGANDDIARRHOEA IN CRITICALLY ILL PATIENTS: K. M.Hillman*, T.W.T. Kelly, M.R.Patrick. St. Bartholomews Hospital & *Channg Cross HospitaldLondon UK. Although diarrhoea in critically ill patients is COMnOnly thought to be associated with enteral feeding, the incidence of it and the association with feeding has not been quantified. Most patients in Intensive Care Units are on a wide variety of antibiotics and the incidence could be related either directly or indirectly to their use or to Clostridia difficile toxin. The study was conducted prospectively on patients admitted for more than 48 hours to a general Intensive Care Unit over a 12 month period. As well as general information about the patient, detailed records were kept on all aspects of enteral and parenteral nutrition, antibiotics, cimetidine and antacids. Twice weekly stool samples were sent for routine bacteriological culture and for the detection of C.difficile. Of the 81 patients, 41% developed diarrhoea. Of the patients havino enteral feeds, 68% developed diarrhoea while 28% who were not having enter-al feeds had‘diarrhoea This was a hiahlv sianificant correlation (PI 0.01). There was also a significant c&relation between cimetidine and the occurrence of diarrhoe (PdO.05). There was no evidence that cross infection played any part in the aetiology of the diarrhoea, nor was there any association between the underlying illness and the occurrence of diarrhoea. Individual antibiotics were not associated with the incidence of diarrhoes nor was there any difference between patients with and without any antibiotics. The cytotoxin of Clostridia difficile was looked for on every patient and not detected. Enteral feeding in critically ill patients is closely associated with the high incidence of diarrhoea. The reason for this and why cimetidine makes the problem worse will be discussed.
F08 INOICATION OF FORMULA AND ELEMENTARY DIET IN SERIOUSLY ILL PATIENTS: K. Bojanowicz. Gastroenterological Clinic, Medical Academy, 9D-223 ibdi, Poland. New prospects for nutrition of seriously ill patients have been created by commercial nutrients which are easily absorbable even in digestion and absorption disorders and ensure full-value nutrition. We administered formula diet and elementary diet to 200 seriously ill patients who could not be nourished perorally by routine methods. The indications for their administration were as follows: ulcerative colitis, unconsciousness following severe traumas, intestinal fistulas and operations on the alimentarv tract. The oatients received nutrients into the alimentarv tract as early as on the lst-2nd post-operative day in doses increasina from 1200 Kcal to 2100 Kcal, indludina 53 to 93 a of protein-per 24 hours, carbohydrates,.fats, vitamins, mineral salts and trace elements.After administration of commercial nutrients a considerably smaller loss of body weight and an increase in blood protein concentration can be observed in comparison with routine nutrition. Commercial nutrients can correct or diminish manifest and especially occult aminoacid nitrogen and magnesium deficiencies and diminish disorders of the metabolism of fats even in patients with malignant tumours. The described method of nutrition of seriously ill patients is simple, safe and more physiological than parenteral nutrition. Commercial nutrients can ensure qualitatively and quantitatively full-value nutrition in seriously ill subjects. Parenteral nutrition can be replaced in many patients by adequately selected nutrients.
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ENTERAL FEEDINGANDDIARRHOEA IN CRITICALLY ILL PATIENTS: K. M.Hillman*, T.W.T. Kelly, M.R.Patrick. St. Bartholomews Hospital & *Channg Cross HospitaldLondon UK. Although diarrhoea in critically ill patients is COMnOnly thought to be associated with enteral feeding, the incidence of it and the association with feeding has not been quantified. Most patients in Intensive Care Units are on a wide variety of antibiotics and the incidence could be related either directly or indirectly to their use or to Clostridia difficile toxin. The study was conducted prospectively on patients admitted for more than 48 hours to a general Intensive Care Unit over a 12 month period. As well as general information about the patient, detailed records were kept on all aspects of enteral and parenteral nutrition, antibiotics, cimetidine and antacids. Twice weekly stool samples were sent for routine bacteriological culture and for the detection of C.difficile. Of the 81 patients, 41% developed diarrhoea. Of the patients havino enteral feeds, 68% developed diarrhoea while 28% who were not having enter-al feeds had‘diarrhoea This was a hiahlv sianificant correlation (PI 0.01). There was also a significant c&relation between cimetidine and the occurrence of diarrhoe (PdO.05). There was no evidence that cross infection played any part in the aetiology of the diarrhoea, nor was there any association between the underlying illness and the occurrence of diarrhoea. Individual antibiotics were not associated with the incidence of diarrhoes nor was there any difference between patients with and without any antibiotics. The cytotoxin of Clostridia difficile was looked for on every patient and not detected. Enteral feeding in critically ill patients is closely associated with the high incidence of diarrhoea. The reason for this and why cimetidine makes the problem worse will be discussed.
F08 INOICATION OF FORMULA AND ELEMENTARY DIET IN SERIOUSLY ILL PATIENTS: K. Bojanowicz. Gastroenterological Clinic, Medical Academy, 9D-223 ibdi, Poland. New prospects for nutrition of seriously ill patients have been created by commercial nutrients which are easily absorbable even in digestion and absorption disorders and ensure full-value nutrition. We administered formula diet and elementary diet to 200 seriously ill patients who could not be nourished perorally by routine methods. The indications for their administration were as follows: ulcerative colitis, unconsciousness following severe traumas, intestinal fistulas and operations on the alimentarv tract. The oatients received nutrients into the alimentarv tract as early as on the lst-2nd post-operative day in doses increasina from 1200 Kcal to 2100 Kcal, indludina 53 to 93 a of protein-per 24 hours, carbohydrates,.fats, vitamins, mineral salts and trace elements.After administration of commercial nutrients a considerably smaller loss of body weight and an increase in blood protein concentration can be observed in comparison with routine nutrition. Commercial nutrients can correct or diminish manifest and especially occult aminoacid nitrogen and magnesium deficiencies and diminish disorders of the metabolism of fats even in patients with malignant tumours. The described method of nutrition of seriously ill patients is simple, safe and more physiological than parenteral nutrition. Commercial nutrients can ensure qualitatively and quantitatively full-value nutrition in seriously ill subjects. Parenteral nutrition can be replaced in many patients by adequately selected nutrients.
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