Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Case Report

Volume 6, Number 4, August 2013, pages 156-160

Enteral Nutrition Related Complications Relevant to Alteration of Formulas in Two Critically Ill Pediatric Patients

Figures

Figure 1.
Figure 1. Daily excreted feces amount (A) and total gastric residuals (B) of case 1. Gastric residuals increased markedly and watery diarrhea occurred after introducing MEIN. After reducing MEIN from 600 mL/day to 550 mL/day, the watery diarrhea improved. However, increased gastric residuals persisted until we discontinued MEIN and decreased dramatically after reintroducing ensure liquid.
Figure 2.
Figure 2. Changes in body temperature (A) and aspartate aminotransferase (AST; rectangle), alanine transaminase (ALT; square) and γ-glutamyl transpeptidase (γ-GTP; triangle) levels (B) in case 2. After beginning Terumeal-mini, the patient became feverish and liver dysfunction deteriorated rapidly. AST and ALT peaked at 857 IU/L and 768 IU/L, respectively. γ-GTP peaked at 192 IU/L. Total bilirubin level remained normal and blood urea nitrogen level temporarily increased when the patient had a fever. After discontinuing the Terumeal-mini and reintroducing the Ensure Liquid, the fever resolved and the liver dysfunction normalized.

Table

Table 1. Comparison of Ensure Liquid, MEIN and Terumeal-Mini
 
Ensure LiquidMEINTerumeal-mini
MCT: medium-chain triglycerides.
Caloric Content (kcal/mL)1.01.01.6
Free Water Content (g/mL)0.850.840.47
Fiber Content (g/mL)00.0120.005
Osmotic Pressure (mOsm/kg)330600470
Calorie-based Combination Ratio of Fat, Protein and Carbohydrates1:1:41:1.8:3.81:1:3.2
Protein SourceCasein, soyCasein, wheyCasein
Fat SourceCorn, soyCanola, palm, fish, MCTSoy
CarbohydratesSucroseIsomaltulose, dextrinSucrose, dextrin