Nutrition and metabolic support in the ICU: nutritional risk and early enteral nutrition, energy and protein targets, feed intolerance, parenteral nutrition and refeeding syndrome, based on ESPEN 2019/2023 and ASPEN 2022.
5 topics
- 01
Nutritional risk and early enteral nutrition
Screen risk (mNUTRIC), start enteral feeding within 24-48 h when resuscitated, and know when to delay.
6 stepsAlgorithmNew - 02
Energy and protein targets
Hypocaloric start (≤ 70% of expenditure) in the first days, advance to 80-100% after day 3, protein about 1.3 g/kg/day, adjust for obesity and count non-nutritional calories.
7 stepsNew - 03
Feed intolerance, gastric residuals and post-pyloric feeding
Define intolerance, use a GRV threshold of 500 mL/6 h, give prokinetics, consider post-pyloric feeding and reduce aspiration risk.
6 stepsAlgorithm2 dosesNew - 04
Parenteral nutrition
When to start PN (severe malnutrition early, others after day 3-7), how to prescribe and monitor, and complications.
6 stepsNew - 05
Refeeding syndrome
Identify risk, start feeds low with thiamine, monitor phosphate, potassium and magnesium, and restrict calories if phosphate falls.
6 steps2 dosesNew
Drugs in this module
Doses written for this module's context. The same drug may read differently in another module.
Erythromycin
Prokinetic (motilin agonist)
Erythromycin
Prokinetic (motilin agonist)
- Indications
- Gastric feed intolerance (first choice in ESPEN)
- Adult dose
- 100-250 mg IV every 8 h for 24-72 h (tachyphylaxis after ~3 days).
- Cautions
- QTc, interactions, antimicrobial resistance.
Metoclopramide
Prokinetic (D2 antagonist)
Metoclopramide
Prokinetic (D2 antagonist)
- Indications
- Gastric feed intolerance
- Adult dose
- 10 mg IV every 8 h; review after 3 days.
- Renal / hepatic
- Halve dose if CrCl < 40.
- Cautions
- Extrapyramidal effects, QTc.
Thiamine
Vitamin B1
Thiamine
Vitamin B1
- Indications
- Refeeding risk; alcohol use; prolonged starvation
- Adult dose
- 100 mg (oral/IV) before starting feeds and daily for 5-7 days (or longer in severe starvation/alcohol use).
Phosphate replacement (potassium or sodium phosphate)
Electrolyte
Phosphate replacement (potassium or sodium phosphate)
Electrolyte
- Indications
- Hypophosphataemia (refeeding)
- Adult dose
- Moderate (1.0-1.9 mg/dL): 0.16-0.32 mmol/kg IV over 4-6 h; severe (< 1.0 mg/dL): 0.32-0.64 mmol/kg IV over 8-12 h (max ~50 mmol per dose); oral phosphate for mild deficits.
- Renal / hepatic
- Reduce doses in AKI; monitor closely.
- Cautions
- Potassium phosphate adds potassium (check K); hypocalcaemia with rapid infusion.
Module references (13)
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