Give the starting strength and flow rate you would use and the progression to the final strength and flow rate. Explain your rationale

Answer 1

Hopefully, when the students try to calculate this out they will discover the following:

1 . The amount calculated above may be more than the patient will tolerate because of the fluid load and protein content. If so, the fat in this formula is low enough that some could be added in the form of MCT oil; 30 cc = 231 kcals. Some could be given as tolerated to reduce the TF volume and to dilute the protein. As it is, the protein provided will be 55 to 73 g. This is too high based on the answer to question 30 . Sixty cc of MCT oil would provide 462 kcals. 2074 - 462 = 1612 kcals/1.5 kcals/cc = 1074 cc and 43 g of protein. This is the closest to the above restrictions we created. Mr. N may not be able to tolerate the MCT oil. Start the tube feeding very slowly and, over several days, gradually add the MCT oil.
2 . Other possibilities are not to use a liver formula but a peptide formula diluted with a smaller amount of MCT oil or to use an intact protein formula that is low protein. The H3 level, the level of consciousness, and the ability to tolerate fluid will be the deciding factors.
3 . Assume the amount calculated above was to be used: 1074 cc /24 hrs = 45 cc/hr. After bleeding, the patient would probably have diarrhea for several days d/t blood in the gut. Therefore, to help facilitate the passage of blood and provide some nutrients, I would start at ½ strength 25 cc/h and increase to ¾ strength after 24 hr, then to FS after another 24 hrs. Assuming tolerance, I would increase 10 cc q 8 hr until about
45 cc/h was obtained. Then I would add 15 cc MCT oil per day as tolerated up to about 45 - 60 cc and decrease TF appropriately.