On post-op day 7 (12/22), Mr. Page's team notes he has had bowel sounds for the previous 48 hours and had his first bowel movement
The nutrition support team recommends consideration of an oral diet. What should Mr. Page be allowed to try first? What would you monitor for tolerance? If successful, when can the parenteral nutrition be weaned?
• Mr. Page can be advanced to a diet consisting of the following: 5-6 small meals. 50% complex carbohydrates with avoidance of simple sugars and FODMAPS such as fructose, high fructose corn syrup and sugar alcohols. Fat should be restricted to <30% of total calories. Protein should be 20-30% of total calories with an emphasis on high biological food choices. Soluble fiber should be emphasized with approximately 5-10 g/day. Limit high oxalate foods.
• The hyperosmolality of clear liquids, which might be typically ordered, may actually increase stool output.
• Any food that causes an increase in diarrhea or pain should be avoided and tried at a later date.
• The use of a lactose-free liquid supplement would be a good choice to increase his overall intake.
• When Mr. Page can consume 60% of his requirements by mouth, the parenteral nutrition can be weaned.
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