Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subty...Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition （TPN）, and the solution for the disease. Methods We collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase （AKP）, and γ-glutamylcyclotransferase （γ-GT）, white blood cell count, and systemic inflammatory reaction syndrome （SIRS） score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student＇s t test and analysis of variance were used to analyze the data. Results Of the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and y-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, （243.0±121.6） U/L and （177.2±109.9） U/L vs. before EF （181.5±127.5） U/L and （118.4±94.2） U/L, P〈0.05], and decreased gradually afterwards. The SIRS scores on the 1st day （1.05±1.08） and 3rd day （0.96±1.11） after EF were significantly higher than that before EF （0.72＋0.84）, then decreased to 0.83±0.91, 0.49±0.73 and 0.32±0.60 on the 5th, 10th and 15th days after EE The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively. Conclusions The longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.展开更多
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despit...Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despite the benefits and widespread use of enteral tube feeding,some patients experience complications.This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special aspects.We conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding syndrome.The literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,hyperglycemia.Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most common.Complications associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.展开更多
Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in pa...Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay.Multiple types of hepatitis may occur in these patients,including two types that occur only in patients with AN:starvation hepatitis and refeeding-induced hepatitis.Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation,such as hypoglycaemia,hypothermia,and hypotension.Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia,hypokalemia,and hypomagnesaemia.Among the most common forms of hepatitis,drug-induced liver injury is particularly relevant in this patient cohort,given the frequent use and abuse of methamphetamines,laxatives,antidepressants,and antipsychotics.In this review,we provided an overview of the different forms of anorexic-associated hepatitis,a diagnostic approach that can help the clinician to correctly frame the problem,and indications on their management and treatment.展开更多
文摘Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition （TPN）, and the solution for the disease. Methods We collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase （AKP）, and γ-glutamylcyclotransferase （γ-GT）, white blood cell count, and systemic inflammatory reaction syndrome （SIRS） score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student＇s t test and analysis of variance were used to analyze the data. Results Of the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and y-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, （243.0±121.6） U/L and （177.2±109.9） U/L vs. before EF （181.5±127.5） U/L and （118.4±94.2） U/L, P〈0.05], and decreased gradually afterwards. The SIRS scores on the 1st day （1.05±1.08） and 3rd day （0.96±1.11） after EF were significantly higher than that before EF （0.72＋0.84）, then decreased to 0.83±0.91, 0.49±0.73 and 0.32±0.60 on the 5th, 10th and 15th days after EE The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively. Conclusions The longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.
文摘Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despite the benefits and widespread use of enteral tube feeding,some patients experience complications.This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special aspects.We conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding syndrome.The literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,hyperglycemia.Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most common.Complications associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.
基金Thanks to Fondazione Roma for the invaluable support for scientific research-FR-CEMAD 21-25.
文摘Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay.Multiple types of hepatitis may occur in these patients,including two types that occur only in patients with AN:starvation hepatitis and refeeding-induced hepatitis.Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation,such as hypoglycaemia,hypothermia,and hypotension.Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia,hypokalemia,and hypomagnesaemia.Among the most common forms of hepatitis,drug-induced liver injury is particularly relevant in this patient cohort,given the frequent use and abuse of methamphetamines,laxatives,antidepressants,and antipsychotics.In this review,we provided an overview of the different forms of anorexic-associated hepatitis,a diagnostic approach that can help the clinician to correctly frame the problem,and indications on their management and treatment.
