Clinical Nutrition Dilemma

On the day that I came back from a conference, I got a consult from a nurse practitioner. He said patient AB was status post allogenic stem cell transplant but with poor food intake, therefore he was newly initiated on enteral nutrition (tube feed) but experiencing diarrhea. The nurse practitioner asked me if there was any other formula that we could switch to to improve AB's diarrhea. During our conversation, I found out AB was ordered on a fiber-containing enteral nutrition formula. Instead of recommending a much more expensive semi-elemental enteral nutrition formula, I recommended that the nurse practitioner switch AB to a fiber-free formula and AB's diarrhea was resolved overnight. The question is: Is fiber good you? The answer is: It depends. According to the Institute of Medicine's Dietary Reference Intake (DRI), an average adult needs about 25 to 38 grams of dietary fiber a day. But most Americans struggle to eat an adequate amount of fiber which is only an...

A brand of enteral nutrition formula just revamped its packaging which almost gave me a heart attack when I first saw it hanging in one of my patient's room. As seen on the above picture, the new packaging in the middle is a 1.5 calorie/mL formula, but the color of this new label is the same color as the old label of a 1 calorie/mL formula that we are used to. At first, I thought the nurse made an error and hung up a wrong formula. I was very close to filing a report with the Patient Safety Net, a portal to report medical errors. But when I looked at the label more closely, it's the same strength of formula that I recommended. Whew~ Think of it this way: our critical care patients are already at high risk of malnutrition. If the hung formula is indeed a 1 calorie/mL, the patient in critical condition is receiving 33% less calories than intended, hospital-acquired malnutrition may result. The next time any manufacturer plans to make changes to their packaging, please ...