Inadequate Intake from Enteral/Parenteral Nutrition

Etiology:

• Altered absorption or metabolism of nutrients, eg medications
• Food and nutrition related knowledge deficit (patient/client, caregiver, supplier) – incorrect formula/formulation given, eg wrong enteral feeding, missing component of TPN
• Lack of, compromised, or incorrect access for delivering EN/TPN
• Increased biological demand of nutrients, eg accelerated growth, wound healing, chronic infection, multiple fractures
• Intolerence of EN/TPN
• Infusion volume not reached or schedule for infusion interrupted

S/S:

• Cholesterol <160 mg/dl
• Metabolic cart/indirect calorimetry measurement, eg respiratory quotient <0.7
• Vitamin/mineral abnormalities:
•         Calcium <9.2 mg/dl
•         Vitamin K – prolonged prothrombin time (PT), partial thromboplastin time (PTT)
•         Copper <70 mcg/dl
•         Zinc <78 mcg/dl
•         Iron < 50 mcg/dl; iron binding capacity < 250 mcg/dl
• Growth failure
• Insufficient maternal weight gain
• Lack of planned weight gain
• Unintentional weight loss of >5% in 1 month or >10% in 6 months (not attributed to fluid) in adults
• Any weight loss in infants/children
• Underweight (BMI <18.5)
• Clinical evidence of vitamin/mineral deficiency (eg hair loss, bleeding gums, pale nail beds, neurologic changes)
• Evidence of dehydration, eg dry mucous membranes, poor skin turgor
• Loss of skin integrity, delayed wound healing, or pressure ulcers
• Loss of muscle mass and/or subcutaneous fat
• N/V/D
• Reports/observations of inadequate EN/TPN volume compared to estimated or measured (indirect calorimetry) requirements
• Conditions associated with diagnosis or treatment, eg intestinal resection, Crohn’s disease, HIV/AIDS, burns, pre-term birth, malnutrition
• Feeding tube or venous access in wrong position or removed
• Altered capacity for desired levels of physical activity or exercise, easy fatigue with increased activity