ENTERAL

Intervensi Gizi
 Enteral
• makanan enteral adalah makanan yang diberikan
pada pasien yang tidak dapat memenuhi kebutuhan
gizinya melalui rute oral, sehingga diberikan melalui
tube ke dalam lambung (gastric tube), nasogastric
tube (NGT), atau jejunum, dapat secara manual
maupun dengan bantuan pompa mesin
 Enteral feeding
“If the gut works – use it”

§ Nasogastric (NG)
§ Nasojejunal (NJ)
§ Percutaneous Endoscopic Gastrostomy (PEG)
§ Percutaneous Endoscopic Jejunostomy (PEJ)
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 Indikasi pemberian enteral

Ø Terdapat masalah saluran cerna (short bowl

syndrome, gastropharesis, crohn disease,
lainnya)
Ø Asupan oral yang tidak adekuat
Ø Terganggunya digesti, absorpsi, metabolisme
Ø Severe wasting (cancer, sirosis, AIDS wasting
Syndrome, lainnya)
 Manfaat enteral
§ Mencegah atrofi mukosa usus
§ Mempertahankan fungsi barrier usus
§ Mencegah translokasi bakteri
§ Mempertahankan/memperbaiki imunitas usus
§ Mengurangi infeksi
§ Menurunkan permeabilitas mukosa usus
§ Mencegah terjadinya katabolisme
§ memperbaiki nitrogen balance negative
§ mempertahankan fungsi GIT
 Komplikasi makanan enteral
• Aspirasi
• Dehidrasi/Overhidrasi, perhitungan/pemenuhan cairan tidak tepat
• infeksi saluran nafas
• Infesksi nosokomial
• Refeeding syndrome, pemberian makanan terlalu agresif
 Syarat makanan enteral
• Osmolaritas : 300-500mOsm/Kg
• Memiliki kepadatan kalori yang tinggi. minimal 1 kkal/ml
cairan, untuk formula standar : 1,2-2,0 kkal/ml
• Kandungan gizi yang seimbang
• Memiliki osmolaritas yang sama dengan osmolaritas
cairan tubuh
• Mudah serap
 Tipe makanan enteral
vProduk Blenderized Products
vPolymeric / Standard Products
vCalorically Dense Products
vElemental and Semi-Elemental Products
vSpecialized / Disease-Specific Products
vModular/ Incomplete Products
vMetabolic Products
 Blenderized Products
§ Blenderized formulas were developed for
individuals with intolerance to semi-
synthetic formulas.
§ These formulas are made from liquefying
actual foods such as chicken, peas,
carrots, tomatoes and cranberry juice.
§ Similar formulas can been made in the
home but “homemade” formulations
carry a risk of bacterial contamination.
 Polymeric / Standard Products
Ø Polymeric or standard formulas are
nutritionally complete. They are made with
intact protein, carbohydrates, long chain
triglycerides, vitamins and minerals.
Ø They may also include fiber and are
administered through an enteral feeding
tube.
Ø Examples: Fibersoure HN, Jevity 1 Cal, Jevity
1.2 Cal, Isosource HN, Nutren 1.0, Nutren
1.0 Fiber, Osmolite 1 Cal, Osmolite 1.2 Cal,
Promote, Promote with Fiber, Nutren
Replete, Nutren Replete with fiber
 Calorically Dense Products
§ Calorically dense formulas are nutritionally complete and
provide more calories than standard enteral products.
§ They may provide equal to or greater than 1.5 kcal /cc.
§ They contain vitamins, minerals protein, carbohydrates,
and mainly long chain triglycerides.
§ These formulas may also include fiber.
 Elemental and Semi-Elemental Products
§ Elemental and semi-elemental enteral formulas are nutritionally complete but their
building blocks are broken down into smaller components.
§ Elemental formulas contain individual amino acids, glucose polymers, and are low fat with
only about 2% to 3% of calories derived from long chain triglycerides (LCT).
§ Medium chain triglycerides (MCT) are the predominant fat source, and can be absorbed
directly across the small intestinal mucosa into the portal vein in the absence of lipase or
bile salts.
§ Semielemental formulas contain peptides of varying chain length, simple sugars, glucose
polymers and fat, primarily as MCT.
Specialized / Disease-Specific Products
§ Specialized / disease-specific products are nutritionally complete and
are designed to meet the needs of individuals with specific disease
states, such as diabetes, renal dysfunction, liver dysfunction,
respiratory dysfunction, acute illness or wound healing.
§ Specialized formulas may contain biologically active substances or
nutrients such as glutamine, arginine, nucleotides or essential fatty
acids
§ Examples: Diabetasol, Glucerna, Nutren Glytrol, Nepro with Carb
Steady, Novasource Renal, Nutrihep, Perative, Pulmocare, Nutren
Pulmonary, Impact, Impact 1.5, and Oxepa, nephrisol
 Modular/ Incomplete Products
§ Modular/ Incomplete products are used to deliver an
additional source of a specific nutrient.
§ They are not designed to meet 100% of estimated nutritional
needs, but can provide additional calories, or protein or fat.
§ They may be taken alone or in combination with other
products.
§ Examples: Duocal, Polycose, Benecalorie, Promod,
Beneprotein, MCT oil, Microlipid, Juven, and other glutamine
containing products
 Metabolic Products
§ Metabolic products are used to in the
dietary management of inborn errors
metabolism such as phenylketonuria,
maple syrup urine disease and
tyrosinemia.
§ Examples: Milupa MSUD2, MSUD
Aid, Periflex Advance and Ketonex 2
PARENTERAL
 DEFINISI
• Nutrisi parenteral (PN) adalah pemberian makanan
melalui intravena, yang meliputi protein, karbohidrat,
Lemak, mineral dan elektrolit, vitamin dan unsur lainnya
untuk pasien yang tidak bisa makan melalui Saluran
Gastrointestinal atau pasien tidak dapat menerima serta
tidak dapat menyerap makanan dengan baik sehingga
dapat berisiko malnutrisi.

• ASPEN, 2012
 INDIKASI
Indikasi penggunaan PN adalah ketika kondisi Saluran gastrointestinal :
• Tidak berfungsi atau kerusakan secara anatomy (misalnya penyumbatan, ileus,
fistula, dismotilitas)
• Tidak dapat diakses (misalnya muntah yang sulit diatasi disertai kesulitan
pemberian makan via jejunum dan rute lain)
• Asupan oral atau enteral tidak adekuat (mis.Pada keadaan malabsorpsi seperti
short bowel syndrome, enteritis atau Ketidakmampuan untuk menerima makanan
enteral secara penuh)
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 Komplikasi Parenteral
Parenteral Nutrisi harganya mahal,kompleks dan dapat menyebabkan komplikasi-2
berikut :
• Komplikasi teknis : berkaitan dengan pemasangan kateter seperti pneumotoraks,
emboli udara
• Komplikasi infeksi : ditandai oleh demam, seperti pada flebitis, infeksi pada tempat
pemasangan
• Komplikasi metabolik: berkaitan dengan gangguan
keseimbangan glukosa (hiper/hipo), elektrolit (hipokalemia,
hiperkalemia)