From the Guidelines
Managing gastrointestinal issues and preventing nutritional deficiencies in high-risk patients requires a comprehensive approach that prioritizes enteral nutrition (EN) as the first choice, with parenteral nutrition (PN) considered for those who cannot meet their nutritional requirements via the enteral route. According to the most recent and highest quality study 1, enteral nutrition should be offered to patients at nutritional risk or malnourished who cannot meet their nutrient requirements by normal dietary intake, have a functioning gastrointestinal tract, and are able to receive therapy outside of an acute care setting.
Key considerations in managing gastrointestinal issues include:
- Implementing small, frequent meals that are low in fat and high in easily digestible nutrients
- Prescribing proton pump inhibitors such as omeprazole 20-40mg daily or H2 blockers like famotidine 20mg twice daily for patients with acid reflux or gastritis
- Using pancreatic enzyme supplements and specific vitamin supplementation for those with malabsorption
- Managing diarrhea with loperamide 2mg as needed and constipation with polyethylene glycol 17g daily or docusate sodium 100mg twice daily
- Regular nutritional screening using tools like the Malnutrition Universal Screening Tool (MUST) to identify deficiencies early
In severe cases, consider enteral nutrition via nasogastric tube or percutaneous endoscopic gastrostomy (PEG) tube feeding, or parenteral nutrition for those with non-functional GI tracts, as recommended by 1 and 1. These interventions work by addressing the underlying causes of GI dysfunction while ensuring adequate nutrient absorption, helping maintain nutritional status and preventing complications like muscle wasting, impaired wound healing, and compromised immune function in vulnerable patients.
It is also crucial to monitor food and fluid intake daily and determine body weight regularly, as suggested by 1, and to consider a variety of methods to maintain and improve intake of food and fluids, including treating specific problems that interfere with intake and providing assistance in feeding if needed.
Overall, a comprehensive approach that prioritizes enteral nutrition and considers the individual needs of high-risk patients is essential for managing gastrointestinal issues and preventing nutritional deficiencies.
From the FDA Drug Label
The adverse effects reported during clinical investigations of loperamide hydrochloride are difficult to distinguish from symptoms associated with the diarrheal syndrome.
Adverse experiences recorded during clinical studies with loperamide hydrochloride were generally of a minor and self-limiting nature
They were more commonly observed during the treatment of chronic diarrhea.
The FDA drug label does not answer the question.
From the Research
Managing Gastrointestinal Issues
To manage gastrointestinal issues and prevent nutritional deficiencies in high-risk patients, several strategies can be employed:
- Identifying patients at nutritional risk to improve hospital-related outcomes 2
- Using specialized nutritional support in the form of oral nutritional supplementation, enteral nutrition, and parenteral nutrition to meet the nutritional needs of patients 2
- Considering disease-specific nutritional considerations to provide quality care to hospitalized patients 2
Preventing Nutritional Deficiencies
Preventing nutritional deficiencies is crucial in high-risk patients:
- Enteral nutrition is preferred over parenteral nutrition in patients with functioning gastrointestinal tracts 3
- Parenteral nutrition can be used in patients with intestinal failure or those who are unable to maintain oral or enteral nutrition alone, but it carries a risk of serious complications 4
- Nutritional strategies during gastrointestinal dysfunction, such as improving nutrient delivery, can help prevent nutritional deficiencies 5
Nutrition Support
Nutrition support is essential in hospitalized patients with malnutrition:
- The use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition can help improve outcomes 6
- However, underutilization of nutrition support may occur due to various factors, such as product shortages and strict adherence to published guidelines 6
- Recent studies have investigated separate components of GI dysfunction in ICU patients, including the role of altered GI motility, nutrient digestion and absorption, and the metabolic consequences of gut dysfunction 5