Newsletter

[ Vol. 9 No. 2 ] (May - August 2008 )
One case in which diarrhea and the nutritional status of the patient were improved because of the change from the half-digested formula to the element

Minoru Miyashita^1-1), Yuka Yamaguchi^1-1), Yukiko Kawashima^1-1), Hiroyuki Hayashi^1-2), Naoko Mihara^1-3), Harumi Yoshimoto^1-3), Misako Kawase^1-3), Ryo Yoshida^1-4),  Hiroyuki Komoriyama^1-5), Hiroshi Suzuki²⁾, Teiji Nakamura^2)
1)St, Marianna University school of Medicine Yokohama city SEIBU Hospital
^1-1)Department of Nutrition ^1-2) Department of Pharmacy ^1-3) Nurses ^1-4) Orthopedics ^1-5) Surgery & NST Cheerman
²⁾Kanagawa University of Human Services, School of Nutrition and Dietetics
E-mail: minoruei@marianna-u.ac.jp

Purpose
Diarrhea is one of the nutritional control problems due to the enteral nutrition. The report was one case in whichdiarrhea of the patient administered with the enteral nutrition was successfully controlled and his nutritional status and his decubitus were improved because of the intervention of the nutrition support team (NST).

Case
The patient was a 75 years old man, who lost 6kg a month of his weight and had intensive malnutrition because of the lowering of his appetite after he impaired his cervical spine caused by falling down the stairs. His height was 160 cm and his weight was 33.9 kg. He had diabetes in the past. He also had decubitus and dysphagia when the NST was requested to work for this case.

Progress
The nutritional requirement of the patient was determined on 1400 kcal per day. At first, he fed deglutition diet. However, after 7 weeks of the NST intervention, he contracted pneumonia cased by an error in swallowing. Then his nutritional status was controlled with the center venous nutrition (CV) and the nasogastric tube nutrition (NG). Next, 840 kcal with the CV (AMINOFLUID) and 300 kcal with the NG (CALORIAN, half-digested formula include in Bifidobacterium bifidum and oligosaccharide) were given to him. After that, the amount of the CV was gradually decreased and the amount of the NG was increased little by little. When 210 kcal with the CV and 1350 kcal with the NG were given to him on the 10^th week, he had water-like feces. However, the CV was stopped on the 12^th week. Then, his nutrition supply at this time was increased by 1350 kcal per day (450 ml x3 times) with CALORIAN (1 kcal/ml) by the NG and it was close to his nutritional requirement. Also, supplementary drinks were given to him to replenish micronutrients to improve his diarrhea. The improvements of his diarrhea and his nutritional status were not shown. Therefore, the concentration of CALORIAN was deepened (1.25 kcal/ml), his administered energy was changed to 1500 kcal a day (400 ml x 3 times), and the administering rate was reduced to 100 ml per hour by using a pump. However, there were not shown any improvement of both his diarrhea and his decubitus. With the purpose due to the improvement of his diarrhea, on the 19th week, the enteral nutrition was changed to the elemental formula, ELENTAL (1.25 kcal/ml) which was given to him the same volume as the haft-digested formula, CALORIAN. On the 20th week, his feces got harder, his diarrhea improved, and the contamination of his decubitus because of his feces was disappeared. The administering rate was gradually increased from the 27th week and the use of the pumps was stopped on the 28^th week. Because ELENTAL was used for a long term, the intravenous administration of the fat emulsion was used together with it.

Observation and Conclusion
Generally, it is said that the enteral nutrition formula including Bifidobacterium bifidum is rare to cause diarrhea and the elemental formula may sometimes lead to diarrhea because of its high osmotic pressure. However, in case of which diarrhea is continued with unknown origin, It should be considered to choose the use of elemental formula.

From  
The 11^th PENSA Congress
October 1-4 2005, Sheraton Grande Walkerhill Hotel, Seoul, Korea. 
Page: 262