Hospitalized patient feeding

WSAVA guideline

Key findings

• Intervention tiers (days incl. at home): ≥5 days — "Nutritional support is required! Place feeding tube or initiate parenteral nutrition"; 3–4 days — support likely needed if recovery not imminent, consider tube if anesthetized; 1–2 days — write feeding orders, monitor intake/condition daily; already malnourished — support "as soon as hemodynamically stable" [Feeding Guide p.1].
• GL2011: assisted techniques for insufficient intake over 3–5 days (incl. reduced appetite at home) [p.8]. ("Assume malnutrition if anorexic >3 d" is NOT printed — use the tiers.)
• RER as printed: "RER 2kg–30kg = BW(kg) x 30 (+70)"; "RER <2kg and >30kg = 70 x BW(kg)^0.75" — linear shortcut explicitly limited to 2–30 kg [Chart].
• Printed RER table (kcal/day): 2 kg 118, 5 kg 234, 10 kg 394, 20 kg 662, 30 kg 897, 40 kg 1113, 60 kg 1509 [Feeding Guide p.2].
• Route ladder: (1) voluntary/coax feeding (warm food, quiet area, owner feeds, stroking) with specific orders e.g., "Feed 1/4 can Diet X orally q 6 hrs" (diet, route, amount, frequency); (2) if inadequate → assisted feeding; syringe feeding cautioned in nauseated/stressed patients (food aversion) [Feeding Guide p.1; GL2011 p.8].
• Tube algorithm: upper GI functional + enteral likely <5 days → nasoesophageal/nasogastric; >5 days → PEG or esophagostomy (laparotomy not indicated); laparotomy indicated → surgical gastrostomy; upper GI non-functional → jejunostomy; entire GI non-functional → parenteral nutrition; "reassess daily for need for parenteral nutrition (3–5 days anorexia)". GL2011: PN also for GI dysfunction or aspiration risk; vigilance in recumbent/neurologic patients.
• Meal volume: "try to avoid meal sizes of more than 10ml/kg" (enteral). % RER options/day: 100/75/50/25% — goal 100% RER but "it may take 2–3 days to reach RER" [Chart; Feeding Guide p.1].
• Refeeding caution: the gradual ramp (reduced starting % RER → full RER by 2–3 days) is the printed safeguard; refeeding syndrome is not named in any local extract [verify].
• Food aversion: offer usual/favorite "comfort" foods; avoid novel foods intended for long-term feeding; force-feeding causes aversion/aspiration pneumonia [GL2011 p.8; FAQ 2018].
• Monitoring chart fields: header — weight today, BCS (9-point), muscle wastage (none/mild/moderate/marked), route (voluntary PO vs tube), diet type (dry/wet/liquid/other), % RER, feeds/day, special considerations, home feeding preferences; daily log — time, diet offered/tube feed, quantity offered (mls/grams), method, quantity eaten, "kcal requirements met per feed? YES/NO", comments.
• Daily monitoring (GL2011): feeding orders; fluid balance (BW changes, crackles, CVP); reassess route daily; quantify intake via all routes; discharge: document feeding method, caloric intake, diet, frequency, monitoring parameters, recheck schedule.

Recommendations

• Count anorexia days from home; ≥5 days = mandatory support (tube or PN)

  GNC Feeding Guide (protocol)

• Malnourished patients: feed as soon as hemodynamically stable

  GNC Feeding Guide

• Feed to 100% RER, reached over 2–3 days from a lower starting % RER

  GNC Feeding Guide + chart (expert consensus)

• Use 30×BW+70 only for 2–30 kg; 70×BW^0.75 outside that range

  GNC chart (NRC-based)

• Write specific feeding orders: diet, route, amount, frequency

  Guideline 2011

• Escalate route per algorithm; jejunostomy for upper-GI dysfunction; PN if entire GI non-functional

  GNC algorithm

• Keep enteral meals ≤10 ml/kg

  GNC chart (expert consensus)

• Comfort foods only; avoid novel long-term diets; no force-feeding in nauseated/stressed patients

  Guideline 2011 + FAQ

Related drugs in this reference (0)

No indication text currently matches this condition by name. Try a broader condition or search the drug reference directly. Absence of a match does not establish that treatment is unavailable.