Figure 1830

Enteral nutrition (tube feeding). The gastrointestinal tract should be used whenever possible because enteral nutrients may help to maintain gastrointestinal function and the mucosal barrier and thus prevent translocation of bacteria and systemic infection [61]. Even small amounts of enteral diets exert a protective effect on the intestinal mucosa. Recent animal experiments suggest that enteral feeds may exert additional advantages in acute renal failure (ARF) patients [63]: in glycerol-induced ARF in rats enteral feeding improved renal perfusion, A, and preserved renal function, B. For patients with ARF who are unable to eat because of cerebral impairment, anorexia, or nausea, enteral nutrition should be provided through small, soft feeding tubes with the tip positioned in the stomach or jejunum [61]. Feeding solutions can be administered by pump intermittently or continuously. If given continuously, the stomach should be aspirated every 2 to 4 hours until adequate gastric emptying and intestinal peristalsis are established. To avoid diarrhea, the amount and concentration of the solution should be increased gradually over several days until nutritional requirements are met. Undesired, but potentially treatable side effects include nausea, vomiting, abdominal distension and cramping and diarrhea. (From Roberts et al. [62]; with permission.)

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