Enteral Feeding in the Hypoalbuminemic Patient

Abstract

Previous studies have correlated intolerance of isotonic, intact protein enteral solutions with hypoalbuminemia. The purpose of this retrospective study was to determine whether the level of serum albumin (SA) influenced tolerance of such an enteral nutrient solution (ENS). All patients who received Entrition during 1987 for a minimum of 48 hr were studied for the first 10 days of enteral feeding. Documentation included SA, medications, stool frequency, gastric residuals (GR), and daily caloric intake. ENS intolerance was defined as greater than 3 stools/day for greater than 48 hr or GR greater than twice the hourly infusion rate for greater than 48 hr. Patients were categorized into two groups: those with SA greater than or equal to 2.5 g/dl (group I) and those with SA less than 2.5 g/dl (group II). Of 88 patients studied, 48 (86%) in group I and 28 (88%) in group II tolerated the ENS. Eight (14%) in group I and 4 (12%) in group II experienced ENS intolerance. There was no statistically significant difference in the frequency of ENS intolerance between these two groups (p less than 0.05). Also, 97% of all those with a SA less than 2.5 g/dl were fed 80% or more of their estimated caloric requirements. We concluded that ENS tolerance was not affected by the SA level and patients with hypoalbuminemia (SA less than 2.5 g/dl) could be fed enterally.

Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients

“…The osmolarity of usual feeds is no longer regarded as a major cause of diarrhea [18]. These results were confirmed by some authors [20,21] but not by all [22]. Several other risk factors for diarrhea have been reported and may depend on the treatment or the severity of the patient's condition.…”

Diarréia nosocomial em unidade de terapia intensiva: incidência e fatores de risco

“…Enquanto BRINSON e KOLTS (10) em estudo prospectivo não-controlado com 35 pacientes de UTI, verificaram que todos aqueles com diarréia apresentavam albumina sérica <2,5 g/dL, PATTERSON et al (36) não observaram esta associação. Embora na casuística presente a albumina sérica à admissão (2,1 g/dL) do grupo com diarréia tenha sido menor que aquela dos pacientes sem diarréia (2,4 g/dL) (Tabela 3), isto não se manteve na análise multivariada (Tabela 4).…”

Tolerance and Utilization of Enteral Nitrogen

“…Brinson and Kolts [34] suggested that hypoalbuminemia in ICU patients with multiple organ failure was one of the factors responsible for an increased incidence of diarrhea with enteral nutrition and that peptide-based formulas could improve enteral nutrition tolerance. Patterson et al [35] did not find a statistically significant difference in enteral nutrition tolerance and diarrhea incidence between patients with serum albumin < or > 25 g/l in a metabolic support unit. Mowatt-Larssen et al [36] found no significant difference in the incidence of diarrhea between critically ill patients fed oligomeric and polymeric formulas, nor was there a significant difference in the incidence of diarrhea in patients with serum albumin concentrations of <25 g/l.…”