High protein enteral tubefeeding solution. NICE guidelines regarding refeeding syndrome, based on a very cautious refeeding regime reaching estimated calorie and protein needs within 7 days, compared to a protocol at Diakonhjemmet Hospital using a higher starting rate, reaching estimated needs within 3 days.

High protein enteral tubefeeding solution. The intervention group, Diakonhjemmets feeding protocol, will start at 20 calories a kg a day, and increasing until estimated needs are met within 3days

Refeeding Syndrome

NICE guidelines regarding refeeding syndrome, based on a very cautious refeeding regime reaching estimated calorie and protein needs within 7 days, compared to a protocol at Diakonhjemmet Hospital using a higher starting rate, reaching estimated needs within 3 days.

Tubefeeding

Diakonhjemmet Hospital

Refeeding Syndrome Among Older Adults

Safe Refeeding of Severely Malnourished Patients 65 Years or Older

Using Jamar Pluss Digital +, Measuring change in kg from baseline, day 4, 7 and at 3months.

Health related quality of life. Questionnaires

Screening instrument for cognitive impairment and delerium.

Measuring bodyweight during patients hospital stay, starting at day one of tubefeeding, and then day 4 and on day 7, and at 3 months after last tubefeeding day (with approximatly one week discrepancy)

Diagnosis set by a medical doctor. C-reactive protein (CRP), erythrocytes, sedimentation rate (ESR), white blood cells (WBC), and differential leukocyte count.

Defined as the total number of hospital days before discharge, either to a nursing home, home with homecare or home without further assistance.

Complications might be: constipation, edema, nausea and vomiting, hypoglycemia and cardiac abnormalities, and tubedislocation

Sissel Urke Olsen

Clinical Dietitian

Norwegian Health Association

Refeeding protocol: Standardised refeeding protocols will be used for each of the patient groups; the control group will start tube feeding at 5 or 10 kcal/kg/day depending on their BMI and increase until needs are met within 7 days. The intervention group will start tube feeding at 20 kcal/kg/day and increase until needs are met within 3 days, but continue feeding minimum of 7days. Electrolytes will be monitored daily The patients will receive100 mg thiamine, and 1 multivitamin/mineral daily, all recorded in the medical journal. The intervention group will receive approximately 40% higher amount of protein and calories compared to the control group in the end of day 7.

Patients and care provider(nurse) will be masked(not informed), Patients will be screened (height and weight) and handgrip strength will be performed by the investigator. Patients will sign a written consent, and then randomized to either the control or an intervention group. Patients will be tested on day 4, 7 and at 3 months by a research assistant/outcome assessor and is blinded treatment allocations. Blood tests are drawn daily. A nurse will administered the tubefeeding according to written orders in the medical journal; nurses are not informed about treatment allocation or the outcome measures. Physicians are informed about the study, but will not know what treatment patients will receive.

F75 with 63% of total energy from carbohydrates, including 10% of energy from lactose (standard F75).

F75 milk with 43% of total energy from carbohydrates, without any lactose, and providing the same amount of energy as standard F75 by increased lipid in the form of medium chain triglycerides.

Malnutrition

Diarrhoea

Metabolic Disturbance

This is the standard F75 milk used worldwide (Control group)

Standard F75 Milk

Modified F75 Milk

Kilifi County Hospital

Coast Provincial General Hospital - Study site

Queen Elizabeth Hospital- Study site

Reformulated F75 Milk to Treat Severe Acute Malnutrition

Randomized Controlled Trial of a Reduced Carbohydrate Formulation of F75 Therapeutic Milk Among Children With Severe Acute Malnutrition

The criteria for stabilisation will be according to WHO guidelines:
- Absence of any WHO danger or emergency signs: obstructed breathing, respiratory distress, cyanosis, shock (delayed capillary refill plus fast & weak pulse plus temperature gradient), severe anaemia (Hb<5g/dl), congestive cardiac failure, impaired consciousness, convulsions, severe dehydration, profuse watery diarrhoea, vomits everything, hypothermia.
and
If there is oedema at baseline, loss of oedema defined as improving from a severe +++ oedema (severe: generalized bilateral pitting oedema including feet, legs, arms and face) to ++ oedema (moderate: no upper arm or upper leg oedema and no facial oedema or from ++ oedema to + (mild: only feet/ankle oedema) or none; and
Tolerating full prescribed volume of F75 feeds and observed to be completing the feeds.

3 or more loose stools in the last 24 hours

Described as the number of days requiring Resomal or IV fluids

Percentage change in weight between admission and day 5

Changes in sodium, potassium, magnesium, calcium, phosphate and albumin between admission and day 3

numbers of episodes of new onset severe clinical deterioration accompanied by one or more of the following features: shock (fast and weak pulse and limb versus core temperature gradient and capillary refill time>3 seconds), respiratory distress (subcostal chest wall indrawing, hypoxaemia (SaO2) or requiring oxygen); impaired consciousness (Blantyre coma score<4) or hypoglycaemia (<3.0 mmol/l);

Time in days from admission to date of discharge

Total days spent in stabilization phase, including periods when the child may go back to the stabilization phase during deterioration

The proportion of children with a diarrheal pathogen detected and plasma and fecal bio makers of gut inflammation and permeability

hypophosphatemia/carbohydrate

Refeeding Syndrome Among Older Adults

Reformulated F75 Milk to Treat Severe Acute Malnutrition

Observing the Changes of Fibroblast Growth Factor 23 in Patients of Tumor Induced Osteomalacia

Täydellisin lääketieteellinen tietokanta tieteen tukemana