DIETS MODIFIED IN

CONSISTENCY
 DIETS MODIFIED IN CONSISTENCY

A. LIQUID DIET
 consists of foods that can be served in liquid or strained form in room
temperature. They are usually prescribed in febrile states, postoperatively i.e.
after surgery when the patient is unable to tolerate solid foods. It is also used for
individuals with acute infections or digestive problems, to replace fluids lost by
vomiting, diarrhea.
 The two major types of liquid diets include: Clear liquid diet and full liquid/fluid
diet.
o CLEAR LIQUID DIET provides foods and fluids that are clear and liquid at
room temperature. The purpose of the clear liquid diet is to provide fluids
and electrolytes to prevent dehydration. It provides some amount of energy
but very little amount of other nutrients. It is also deficient in fiber. Hence it
is nutritionally inadequate and should be used only for short periods i.e. 1-2
days. An average clear liquid diet contains 600 to 900Kcal, 120 to 200g
carbohydrate, minimal fat 5 to 10g protein and small amount of sodium and
potassium (electrolytes). The clear liquid diet is usually useful in situations
when the gastrointestinal tract has to be kept functionally at rest. It is also
prescribed before and after certain types of surgery involving the mouth or
gastrointestinal tract. Also, may be used in acute vomiting or diarrhea.
 Examples of clear liquid diet: Water, strained fruit juices, coconut water, lime
juice, whey water, barley/arrowroot watrice kanji, clear dal soup, strained
vegetable or meat soup, tea or coffee without milk or cream, carbonated
beverages, ice pops, plain gelatin are some examples of clear liquid diet.

o FULL LIQUID DIET provides food and fluids that are liquid or semi liquid at room
temperature. It is used as a step between a clear liquid diet and a regular diet.
The purpose of the full liquid diet is to provide an oral (by mouth) source of fluid
for individuals who are incapable of chewing, swallowing or digesting solid food.
It provides more calories than the clear liquid diet and gives adequate
nourishment, except that it is deficient in fiber. It is indicated for post-operative
patients and for gastrointestinal illness.
An average full liquid diet can provide approximately 1000 to 1800 calories and
50 to 65g of protein and adequate minerals and vitamins. The nutritive content
of the full liquid diet can be increased by using protein, vitamin and fiber
supplements.
 Examples of full liquid diet: Foods allowed or included in a full liquid diet
include beverages, cream soups, vegetable soups, strained food juices,
lassi/butter milk, yogurt, hot cocoa, coffee/tea with milk, carbonated
beverages, cereal porridges (refined cereals) custard, sherbet, gelatin,
puddings, ice cream, eggnog, margarine, butter, cream (added to foods),
poached, half boiled egg etc.
o COLD LIQUID DIET also termed as TONSIL diet, is food preparation includes
serving cold or iced liquids. This diet varies depending on the severity of the
patient’s condition, age and overall health status. Usually, patients are instructed
to refrain from eating solid foods for a day or two only since this diet does not
provide adequate nutrition.
 Purpose of a Cold Liquid Diet
 The aim of prescribing a cold liquid diet is to promote relief to fresh mouth sores or following
tonsillectomy. Serious symptoms of the condition following surgery effectively subside
through this diet together with proper medication therapy.
 Guidelines in Preparing for a Cold Liquid Diet
 C – Consult a nutritionist or a doctor before initiating this diet. The cold liquid diet is not
nutritionally adequate. Hence, you should not risk your health without proper medical advice.
 O – Only soothing fluids are allowed in this diet. Selected items should be free from irritants
and acid preparations. Wine, alcoholic beverages, coffee and etc are strong irritants and
should be avoided.
 L – Let the client shift to mechanical soft diet first before launching this diet. The process of
shifting the diet to cold liquids should be gradual.
 D – Duration of the diet should only be two to three days to avoid risking your health
condition. A high protein beverage can be served between meals to provide nutrients needed
by the body.
Foods Allowed:
 Fresh fruit juice – iced or cold
 Commercial fruit juices – iced or cold
 Blended fresh fruits – fresh or cold
 Fruit shake – iced or cold
 All chilled milk
 Dairy or non-dairy chilled yogurt
 Cold thin cereal as a rice substitute
 Any cold thin soup
 Plain ice cream
 Popsies
 Plain sherbet
 Cold soft custard
 Cold jello or gelatin
Foods NOT Allowed:
 All solid, hard and hot foods
 Wine and alcoholic beverages
 All hot beverages
 Tea and coffee
 Strong-flavored fruit juices
B. SOFT DIET
 as the name suggests provides soft whole food that is lightly seasoned and are
similar to the regular diet. The term 'soft' refers to the fact that foods included in
this type of diet are soft in consistency, easy to chew and made of simple, easily
digestible foods.
 It does not contain harsh fiber or strong flavors. It is given during acute
infections, certain gastrointestinal disorders and at the post-operative stage to
individuals who are in the early phase of recovery following a surgery.
 The soft diet provides a transition between a liquid and a normal diet i.e. during
the period when a patient has to give up a full liquid diet but is yet not able to
tolerate a normal diet. Soft diet can be nutritionally adequate (providing
approximately 1800-2000 calories, 55-65g protein) provided the patient is able
to consume adequate amount of food.
 Examples of soft diet: A soft diet freely permits the use of cooked vegetables, soft raw fruits
without seeds, broths and all soups, washed pulses in the form of soups and in combination
of cereals and vegetables, breads and ready-to-eat cereals (most preferable refined such as
poha, upma, pasta, noodles etc.), milk and milk beverages, yogurt, light desserts (including
kheer, halwa, custard, jelly, ice cream), Egg and tender and minced, ground, stewed meat and
meat products, fat like butter, cream, vegetable oil and salt and sugar in moderation. Foods to
be best avoided in the soft diet include coarse cereals, spicy highly seasoned and fried foods,
dry fruits and nuts, rich desserts.
 Among the soft diet is also the mechanical soft diet also known as the dental diet which is a
normal diet that is modified only in texture for ease of mastication i.e. chewing. When an
individual cannot chew or use facial muscles for a variety of dental, medical or surgical
conditions mechanical soft diet is recommended. Elderly persons who have dental problems
are prescribed mechanical soft diets. The food in mechanical soft diet is similar to the soft
diet and may be full liquid, chopped, pureed or regular food with soft consistency. Simple
salads, fruit salads and cottage cheese may be included. No food is restricted unlike in the
case of the customary soft diet. Just removing the skin and seeds, cutting or chopping the
food into small fine pieces are processes usually employed
C. BLAND DIET
 A bland diet is made of foods that are soft, not very spicy and low in fiber. It
consists of foods which are mechanically, chemically and thermally non-
irritating i.e. are least likely to irritate the gastrointestinal tract. Individuals
suffering from gastric or duodenal ulcers, gastritis or ulcerative colitis are
prescribed this diet.
 Foods Included: Milk and milk products low in fat or fat free; Bread, pasta
made from refined cereals, rice; cooked fruits and vegetables without peel
and seeds; Eggs and lean tender meat such as fish, poultry that are steamed,
baked or grilled; Cream, butter; Puddings and custards, clear soups.
 Foods Avoided: Fried, fatty foods; Strong flavored foods; Strong tea, coffee,
alcoholic beverages, condiments and spices; High fiber foods; hot soups and
beverages; whole grains rich in fiber; strong cheeses.
D. RESIDUE RESTRICTED DIET
 The residue restricted diet provides food low in fiber which will result in a small
amount of fecal material in the lower bowel. This diet is used prior to surgery of
the gastrointestinal tract. It may also be used following gastrointestinal surgery.
For a more restricted residue diet, a clear liquid diet can be served for a short
duration. Dietary fibers that are restricted include hemicellulose, pectin
substances, mucilage, lignin and cellulose.
 This diet includes foods which are not stimulating to the lower gastrointestinal
tract and are almost completely digestible, in order to reduce (not eliminate) the
residue in the colon.
 Hot and cold foods are eaten slowly.
 Milk and milk products are limited to 2 cups daily. For a greater restriction of
residue in the colon, milk should be eliminated.
 Fruits and vegetables that contain 2.0 grams or less of dietary fiber per 100
grams edible food are allowed in controlled amounts.
 Digestibility of fiber is not appreciably altered by reducing particle size through
pureeing or blending.
 Prune juice may need to be limited due to its laxative effect.
 Ripe bananas, grapefruit; baked apple (without skin); cooked or canned fruits
without seeds; white grapes, cherries, pineapple, plums, applesauce, peaches,
apricots, mandarin oranges; jellied cranberry sauce; all fruit juices.
 Baked, broiled, creamed or stewed: very tender beef, chicken, lamb, liver, fish,
sweetbreads, tuna, turkey, salmon, veal, lean pork, crisp bacon, canned ham,
shellfish. Sugar, clear jelly, honey, syrup, hard candies, milk chocolate, gumdrops,
marshmallows.
E. LOW FIBER
 Fiber is the part of fruits, vegetables and grains not digested by your body. A low-
fiber diet restricts these foods. As a result, the amount of undigested material
passing through your large intestine is limited and stool bulk is lessened.
 A low-fiber diet may be recommended for a number of conditions or situations. It
is sometimes called a restricted-fiber diet.
 A low-fiber diet limits the types of vegetables, fruits and grains that you can eat.
Occasionally, your doctor also may want you to limit the amount of milk and milk
products in your diet. Milk doesn't contain fiber, but it may contribute to
discomfort or diarrhea, especially if you're lactose intolerant.
 The ability to digest food varies from person to person. Depending on your
condition and tolerance, your doctor may recommend a diet that is more or less
restricted.
o Purpose
 Doctor may prescribe a low-fiber diet if:
 Medical conditions with narrowing of the bowel due to a tumor or an inflammatory
disease
 Before bowel surgery
 Having treatment, such as radiation, that damages or irritates your digestive tract
o Avoid these foods and products made with them:
 Nuts, seeds, dried fruit and coconut
 Whole grains, popcorn, wheat germ and bran
 Brown rice, wild rice, oatmeal, granola, shredded wheat, quinoa, bulgur and barley
 Dried beans, baked beans, lima beans, peas and lentils
 Chunky peanut butter
 Fruits and vegetables except those noted below
 o Choose these foods:
 Tender meat, fish and poultry, ham, bacon, shellfish, and lunch meat
 Eggs, tofu and creamy peanut butter
 Dairy products if tolerated
 White rice and pasta
 Baked goods made with refined wheat or rye flour, such as bread, biscuits,
pancakes, waffles, bagels, saltines and graham crackers
 Hot and cold cereals that have less than 2 grams of dietary fiber in a single
serving, such as those made from rice
 Canned or well-cooked potatoes, carrots and green beans
 Plain tomato sauce
 Vegetable and fruit juices
 Bananas, melons, applesauce and canned peaches (no skin)
 Butter, margarine, oils and salad dressings without seeds
DIETS MODIFIED IN
COMPOSITION
 DIETS MODIFIED IN COMPOSITION

LOW CALORIE

 An eating plan used to help people lose weight. It involves limiting the overall
number of calories you eat or drink in a day.
 It also known as weight-loss diet.
 Following low-calorie diet typically means consuming around 1,200-1,500
calories in a day and must contain the right nutrients.
 Low calorie diet is not recommended for everyone including pregnant or
breastfeeding women(who need enough calorie to sustain their growing babies
as well as themselves) and athletes (who need the energy from sufficient
calories to perform).
 What to eat:
1. Fruits
2. Vegetables
3. Lean proteins
4. Low or no fat dairy products
5. Whole grains
6. Herbs and spices- use them to add flavor to your food without adding calories
 What not to eat:
1. Refined carbohydrates
2. High fat foods
3. Sweetened beverages- add up a lot of calories quickly
 Advantage: accessible, effective and safe
 Disadvantage: potential for increased hunger, requires careful planning and
tracking, not for everyone

HIGH CALORIE DIET

 It leads to weight gain

 Healthcare providers recommended high calorie diet because the body is
currently burning more calories that a person is taking in
 Medical conditions and other causes that make it hard to gain weight includes:
1. Cancer
2. Eating disorders
3. Type 1 diabetes
4. Hyperthyroidism
5. Stress, depression or anxiety
6. Infections such as HIV/AIDS, TB, parasites and others
7. Celiac disease
8. Medications that causes nausea and vomiting including chemotherapy
9. Diarrhea
10. Active calorie burner(burn lots of calories at job, very physically active, frequent workout)
 Aim to eat 300-500 more calories per day to gain weight slowly.
 Foods high in calorie includes:
1. Proteins- red meats, pork, chicken with skin on (roast or broil, not deep fried),
salmon, beans, whole milk, eggs, cheese, full fat yogurt
2. Carbohydrates – potatoes, brown rice, whole grain pasta, whole grains, whole
grains breads
3. Fats – nuts and nut butters, olives, avocado, butter, salad dressings, mayonnaise,
high fat cheeses
LOW PROTEIN

 A women need at least 50gms of protein per day and men about 60gms per day.
 Low-protein requires restriction on the amount of protein consumed, typically
constitutes 4-8% of your daily calories.
 Protein is vital to health, but reducing protein intake can be therapeutic for
people with specific conditions. In particular, low protein diet may benefits those
with decreased kidney or liver function. May be also necessary for those with
disorders that affect protein metabolism, such as homocystinuria and
phenylketonuria.
 It is challenging to reduce protein intake and requires careful planning to meet
the nutritional needs.
 On a low-protein diet, a person should consume plenty of fruits, vegetables,
grains and healthy fats and minimal amount of protein food.
 Healthy low-protein foods include:
1. Fruits – apples, bananas, pears, peaches, berries, grapefruit
2. Vegetables – tomatoes, asparagus, peppers, broccoli, green leafy
3. Grains- rice, oats, bread, pasta, barley
4. Healthy fats – avocados, olive oil and coconut oil
HIGH PROTEIN

 Diet in which 20% or more of total daily calories comes from protein. Most high
protein diets are high in saturated fat and severely restrict intake of
carbohydrates.
 When carbohydrate intake is cut out, a person lose weight quickly because of
water lose. Then, with no extra carbs, the body begins burning more fat for fuel.
These leads to ketosis, which make losing weight easier because a person feel
less hungry. Ketosis may cause temporary headeahes, irritability, nausea, bad
breath and sleeping problems for some people.
 Foods high in protein includes: Bean, Meats, Nuts, Grains, Eggs, Seafood,
Cheese, Soy
 LOW FAT DIET
 Low fat diets are intended to reduce the occurrence of conditions such as heart
diseases and obesity.
 A low fat diet is one that restricts fat and often saturated fat and cholesterol as
well.
 A general rule is that if a provides 100 calories and it has 3 grams or less of fat,
then it is a low-fat food.
 This diet may be given to people with health problems that make it hard to
process fat. This includes problems like long-term pancreatitis and gallbladder
Low fat diet foods includes:

 Whole grain foods – such as oats and higher fibre versions of pasta, rice and
bread.
 Lean meats – such as skinless chicken and turkey.
 White fish.
 Reduced fat dairy – skimmed milk and low fat yoghurt and cheese.
 Vegetables.
 Lentils.
 Fruit.
LOW CHOLESTEROL DIET

 This diet is designed to reduce fat and cholesterol blood levels. The diet goals
are: decrease total dietary fat, especially saturated and trans fat, also known as
hydrogenated fat.
 The body needs some cholesterol to work properly. But if a person have too
much in your blood, it can stick to the walls of the arteries and narrow or even
block them. This puts a person at risk for coronary artery disease and other
heart diseases
 Foods low in cholesterol includes:
1. Oaths
2. Barley and whole grains
3. Beans
4. Banana and lady finger
5. Nuts
6. Vegetable oils
7. Apple, grapes, strawberries and citrus fruits
8. Soy
 LOW CARBOHYDRATES DIET


 A low carb diet is one that limits carbohydrates, primarily found in sugary foods,
pasta, and bread.
 Complications such as heart arrhythmias, cardiac contractile function
impairment, sudden death, osteoporosis, kidney damage, increased cancer risk,
impairment of physical activity and lipid abnormalities can all be linked to long-
term restriction of carbohydrates in the diet.
 Very low carb diets may not be suitable for everyone, including children, people
who are pregnant, and those with certain underlying chronic health
conditions, unless under medical supervision. That's why it's best to talk with
your doctor or dietitian before lowering your carb intake drastically.
 Low-carb foods include:

1. lean meats, such as sirloin, chicken breast, or pork.

2. fish.
3. eggs.
4. leafy green vegetables.
5. cauliflower and broccoli.
6. nuts and seeds, including nut butter.
7. oils, such as coconut oil, olive oil, and rapeseed oil.
8. some fruit, such as apples, blueberries, and strawberries.
LOW SODIUM DIET
 People with certain medical conditions such as high blood pressure, kidney
disease, and heart problems can benefit from a diet that is lower in sodium.
 A low-sodium diet is important to follow in order to control your heart failure
symptoms and prevent future heart problems. Limiting your sodium and fluid
intake will help prevent and control the amount of fluid around your heart,
lungs, or in your legs.
 Foods low in sodium includes:
1. Fresh or frozen fish or shellfish.
2. Chicken or turkey breast without skin or marinade.
3. Lean cuts of beef or pork.
4. Unsalted nuts and seeds.
5. Dried beans, peas, and lentils — like black beans and garbanzo beans (chickpeas)
LOW POTASSIUM DIET
 Eating a lower-potassium diet can help treat and lower the risk of developing
hyperkalemia.
 Eating a lower-potassium diet can help treat and lower the risk of developing
hyperkalemia.
 A low-potassium diet, therefore, may be recommended if a patient have: Kidney
failure, Type 1 diabetes, Addison’s disease
 Low potassium foods:
1. Apples (plus apple juice and applesauce)
2. Blackberries
3. Blueberries
4. Cranberries
5. Fruit cocktail
6. Grapes and grape juice
7. Asparagus (6 raw spears)
8. Broccoli (raw or cooked from frozen)
9. Cabbage
10. Carrots (cooked)
11. Cauliflower
12. Celery (1 stalk)
13. Corn (half an ear if it's on the cob)
14. Cucumber
15. Eggplant
16. Cookies (no nuts or chocolate)
17. Noodles
18. Pasta
19. Pies (no chocolate or high-potassium fruit)
20. Rice
21. Tea (16 ounces max)
LOW PURINE DIET

 Purines are chemicals that are naturally found in certain foods and drinks. When
your body breaks down these chemicals, uric acid is the byproduct. A low-purine
diet reduces the foods and drinks with the highest purine content to reduce
uric acid.
 A low purine diet will typically center around fruits, vegetables, and whole
grains. The diet will minimize the consumption of red meat, seafood, and
alcohol. Healthcare professionals often recommend a low purine diet for people
who have gout, kidney stones, or a similar condition.
 Foods low in purine includes:

1. Low-fat and nondairy fat products, such as yogurt and skim milk.
2. Fresh fruits and vegetables.
3. Nuts, peanut butter, and grains.
4. Fat and oil.
5. Potatoes, rice, bread, and pasta.
6. Eggs (in moderation)
FEEDING
TUBE FEEDING
 Tube feeding is a way of getting your body the nutrition it needs.
 Tube feed is a liquid form of food that's carried through your body through a
flexible tube.
 The nutrients within the tube feed are similar to what you would get from
normal food.
 They are also digested in the same way.
 Tube feeds contain all the nutrients you need daily, including carbohydrates,
protein, fats, vitamins, minerals and water.
1. ENTERAL FEEDING
 Enteral feeding refers to intake of food via the gastrointestinal (GI) tract. The GI
tract is composed of the mouth, esophagus, stomach, and intestines.
 Enteral feeding may mean nutrition taken through the mouth or through a tube
that goes directly to the stomach or small intestine. In the medical setting, the
term enteral feeding is most often used to mean tube feeding.
 A person on enteral feeds usually has a condition or injury that prevents eating a
regular diet by mouth, but their GI tract is still able to function.
 Tube feedings may become necessary when you can’t eat enough calories to
meet your nutritional needs. This may occur if you physically can’t eat, can’t eat
safely, or if your caloric requirements are increased beyond your ability to eat.
TYPES OF ENTERAL FEEDING
 Your feed can be given to you using one of the following types of tubes:
 Nasogastric feeding tube (NG)
 Nasojejunal feeding tube (NJ)
 Gastrostomy tubes, e.g. percutaneous endoscopic gastrostomy (PEG),
radiologically inserted gastrostomy (RIG)
 Jejunostomy tubes, e.g. surgical jejunostomy (JEJ), jejunal extension of
percutaneous endoscopic gastrostomy (PEG-J).
 Your healthcare professional will recommend the type of feeding tube that's
best for you.
 Gastrostomy and jejunostomy tubes are less visible than NG or NJ tubes. They
need to be placed during a surgery. This forms the so-called stoma site.
 NG or NJ tubes do not need surgery for placement. They are more visible than a
gastrostomy or jejunostomy tube. But putting in NG or NJ tube may cause
discomfort
TYPE OF FEEDING TUBE
Nasogastric (NG) feeding tube
Nasojejunal (NJ) feeding tube
Gastrostomy tube (e.g. PEG or
RIG)
Jejunostomy tube (e.g. JEJ or
PEG-J)
WHERE THE TUBE IS INSERTED WHEN IT'S USED
Through the nose, down the Usually for short- term tube
oesophagus and into the stomach feeding (six to eight weeks)
Through the nose, down the
oesophagus, through the stomach
and into the small intestine When feeding into the stomach
(jejunum) isn't tolerated
Directly into the stomach through
a small incision in the abdomen's For long-term use (more than six
skin weeks)
Through the stomach and into the
small intestine (jejunum) (PEG-J)
or directly into the small
intestine (jejunum) (JEJ) through
a small incision in the abdomen's For long-term use (more than six
skin weeks)
Contraindication
 The main reason a person wouldn’t be able to have enteral feeds is if their
stomach or intestines aren’t working properly.
 Someone with a bowel obstruction, decreased blood flow to their intestines
(ischemic bowel), or severe intestinal disease such as Crohn’s disease would
likely not benefit from enteral feedings.
Possible complications of enteral feeding
 There are some complications that can occur as a result of enteral feeding. Some
of the most common include:
 aspiration, which is food going into the lungs
 refeeding syndrome, dangerous electrolyte imbalances that may occur in people
who are very malnourished and start receiving enteral feeds
 infection of the tube or insertion site
 nausea and vomiting that may result from feeds that are too large or fast, or
from slowed emptying of the stomach
 skin irritation at the tube insertion site
 diarrhea due to a liquid diet or possibly medications
 tube dislodgement
 tube blockage, which may occur if not flushed properly
 TYPER OF ENTERAL FORMULAS
1. Intact- also called polymeric formulas, contain unaltered molecules of proteins, carbohydrates,
and fats. They are best for people who can digest and absorb nutrients without difficult
2. Hydrolyzed – a predigested formula
3. Modular - a formula consisting of a singular macronutrient. A complete diet can be formulated
by mixing modular formulations

 FEEDING ADMINISTRATION
1. Continous Drip
 Continuous drip feeding may be delivered without interruption for an unlimited period of time
each day. However, it is best to limit feeding to 18 hours or less.
 Feeding around the clock is not recommended as this limits a child's mobility and may elevate
insulin levels contributing to hypoglycemia.
 Commonly, it is used for 8 to 10 hours during the night for volume-sensitive
patients so that smaller bolus feedings or oral feeding may be used during the
day.
 Continuous drip feeding is delivered by either gravity drip or infusion pump. The
infusion pump is a better method of delivery than gravity drip. The flow rate of
gravity drip may be inconsistent and, therefore, needs to be checked frequently.
 One advantage of continuous feeding over bolus feeding is that it may be
tolerated better by children who are sensitive to volume, are at high risk for
aspiration, or have gastroesophageal reflux.
 Continuous feeding can be administered at night, so it will not interfere with
daytime activities. Continuous feeding increases energy efficiency, allowing more
calories to be used for growth. This can be important for severely malnourished
children.
 When feedings are delivered continuously, stool output is reduced, a
consideration for the child with chronic diarrhea. Continuous infusions of
elemental formula have been successful in managing infants with
short bowel syndrome, intractable diarrhea, necrotizing enterocolitis, and
Crohn's disease.
 A disadvantage of continuous feeding is that the child is "tied" to the feeding
equipment during the infusion, although feedings can be scheduled for night
time and naptime feedings. Additionally, continuous feeding is more expensive
because of the cost of the pump and additional feeding supplies which may be
necessary. A child's medication needs to be considered as continuous feeding
may interfere with serum concentration of some drugs.
1. Bolus
 Bolus feeding is a way of receiving a set amount of feed as required, without use
of a feeding pump. This is given over a period of time, as advised by your
healthcare professional, using an enteral feeding syringe.
 Feedings are most often given every 4 to 6 hours during waking hours.
 There are different ways of bolus feeding. Your healthcare professional will
advise on the best method for you.
 1. Gravity feeding (with or without a gravity feeding set), where gravity
naturally draws the feed through into feeding tube, OR
 2. Syringe feeding, where the feed may need help to be pushed through your
feeding tube using the syringe with its plunger.
PARENTERAL FEEDING
 Parenteral nutrition means feeding intravenously (through a vein).
 Parenteral means "outside of the digestive tract."
 Parenteral nutrition bypasses your entire digestive system, from mouth to anus.
 Certain medical conditions may require parenteral nutrition for a short or longer
time. Some people need it to supplement their diet, and some people need to
get all of their calories intravenously.
Two types of parenteral nutrition
1. Partial parenteral nutrition (PPN) is parenteral nutrition given to supplement
other kinds of feeding. If you’re eating but still have malnutrition, healthcare
providers may offer you partial parenteral nutrition to replace missing elements
in your diet or give you additional calories.

2. Total parenteral nutrition (TPN) is complete nutrition delivered intravenously to

people who can’t use their digestive systems at all. TPN might be required when
certain conditions impair your ability to process food and absorb nutrients
through your digestive tract, or when you need to avoid using your digestive
system for a while so it can heal.
Contraindications
 Parenteral nutrition is not indicated if gastrointestinal tract is fully functional with adequate
absorption of macro and micronutrients.
 Parenteral nutrition is not a treatment of choice when administration of parenteral nutrition is
anticipated for less than 5 days in patients without severe malnutrition.

Complications
 One of the most dramatic side effects of parenteral nutrition is the so-called refeeding
syndrome, which can occur in severely malnourished patients who are receiving aggressive
parenteral nutrition.

 In addition, hyperglycaemia can occur due to parenteral carbohydrate intake in diabetic patients,
in response to postaggression metabolism or the systemic inflammatory response syndrome
(SIRS), or due to systemic steroid therapy. In extreme cases PN can result in a hyperosmolar,
hyperglycaemic non-ketotic coma.
 When suddenly discontinuing parenteral intake, rebound hypoglycaemia,
although rare, may occur. Abnormalities in the acid-base-balance can occur due
to parenteral nutrition and may result in significant electrolyte shifts.
Hypertriglyceridemia with dyslipoproteinaemia may occur. High carbohydrate
intakes may result in excessive carbondioxide production. Hepatic complications
of parenteral nutrition include steatosis (fatty liver) and cholestasis.

 Special complications like metabolic bone disease with bone demineralisation

and osteoporosis may occur in patients receiving long-term parenteral nutrition.
In all forms of parenteral nutrition there is an imminent risk of infectious
complications.

 Finally, intestinal side-effects (mucosal atrophy, increased translocation of micro

organisms and their toxins) may also occur.
God bless!!!