ANDRIANA PURNAMA

Side Effects Of Nutrition

Intervention Therapy
SUB-BAGIAN BEDAH DIGESTIF RSHS BANDUNG

Objectives

Oral, Enteral and Parenteral Nutrition is

beneficial and life-saving in a variety of clinical
conditions, but can also result in numerous,
potentially serious side effects:

Objectives
Refeeding Syndrome
Hyperglycemia, Hypertriglyceridemia
Catheter Infections
Bone Demineralisation
Intestinal Complications
Hepatic Complications

Back Ground

Oedema, Cardiac and

Pulmonary insufficiency

Back Ground
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Total Poisonous
Nutrition

Refeeding Syndrome
A syndrome consisting of metabolic disturbance
that occur as a result of reinstitution of nutrition
to patients who are starved or severely
malnourished
Occurs during the first few days after initiating
refeeding

American Society for Parenteral and Enteral Nutrition. Perioperative Nutrition: What is
the Current landscape.Journal of Parenteral and Enteral nutrition Vol 37 Supl Sept 2013
5S-20S.

Symptoms
Diarrhoea, Nausea, Vomiting
Oedema, Cardiac and Pulmonary insufficiency
Hypophosphataemia, Hypokalemia,
Hypomagnesaemia
Vitamin B1 deficiency
Cardiac Arrhythmia, Congestive Heart Failure

Phatophisiology

IrSPEN Identification & Management of

Patients at Risk of Refeeding Syndrome
(RFS) initially developed for Beaumont
Hospital

IrSPEN Identification & Management of

Patients at Risk of Refeeding Syndrome
(RFS) initially developed for Beaumont
Hospital
Risk by patient category*
Chronic alcohol abuse
Elderly living alone
Chronic GI symptoms
Chronic debilitating disease
Eating disorders
Chronic severe dieting
Oncology patients
Obviously malnourished

IrSPEN Identification & Management of

Patients at Risk of Refeeding Syndrome
(RFS) initially developed for Beaumont
Hospital

Long-Term Home Total Parenteral Nutrition

Complications of Long-Term TPN

Infections: Catheter Sepsis, Exit site Infection,
Tunnel Infection
Catheter Occlusion: Thrombosis, Mineral or Lipid
precipitate
Renal: Decrease GFR, Tubular Dysfunction
Gastrointestinal: Gastroparesis, Intestinal
Hypoplasia

Complications of Long-Term TPN

Metabolic Bone Disease: Osteomalacia,
Osteoporosis
Hepatic and Biliary Disease: Cholestasis, Biliary
Sludge, Gallstones

Catheter Infection

Algorithm for the

diagnosis and
treatment of catheter
related infections

General recommendations
Raise awareness within all health care
personnel
Be aware of patients at risk
Provide adequate assessment, interdisciplinary
care plans, and follow up
Appreciate that risks apply whether patients are
fed by the oral, enteral or parenteral route

Summary
Water and Electrolyte balance, blood sugar, and
cardiovascular function should be regulary
monitored in order to detect a refeeding
syndrome
The risk of such complications can be minimised
by carefully monitoring patients and the use of
nutrition support teams

TERIMA KASIH