Diet in Critically ill Dialysis Patient

By Mrinal Pandit, Chief Dietician, NephroPlus

It is challenging for health care workers to manage and achieve nutritional goals when normal food intake through mouth is not possible and they have to switch to alternate mode of feeding. With CKD, it becomes even more difficult as the too many dietary restriction and limited volume leaves them with very little food options.

Tube feeding

• The tube is usually placed into the stomach, duodenum or jejunum via either the nose, mouth or the direct       percutaneous route.
• The tube can also be used to suction stomach contents like toxins and bile’s.
• The healthcare providers use the tube to feed the patient with powdered medicine, multivitamins and food.

When is it indicated?
• When there is facial or head injury, where chewing is restricted.
• When patient is on ventilator support.
• Unconscious patient.
• The patient has abdominal obstruction, blockage or malabsorption .

Aim of Tube feeding
• Maintain the nutritional status of the patient
• Delay risk of infection and sepsis.

Sample Tube feeding chart for patient on dialysis

Time of Meal                  Feed                                         Quantity

6:00 am                  Milk Supplement feed                   100 ml

8:00 am                  Rawa Kanji Feed                             100 ml

10:00  am              Buttermilk Egg Feed                      100 ml

12:00 pm                Rice Kanji Feed                               100 ml

2:00 pm                  Kitchen Feed                                    100 ml

4:00 pm                  Milk Supplement Feed                  100 ml

6:00 pm                 Buttermilk Egg Feed                       100 ml

8:00 pm                  Kitchen Feed                                    100 ml

10:00 pm               Buttermilk Egg Feed                       100 ml

12:00 pm               Milk Supplement Feed                   100 ml

                                                          Total                               1000 ml

The proportion of the ingredients used to make the feed and the volume may vary with each patient as the nutritional needs changes with every medical condition, age and gender. The kitchen based feeds alone cannot reach the nutritional requirement, as the volume of the feed is restricted. It is advised to have a combination of commercial based formulation and kitchen based formula to reach the nutritional goals.

Malted cereals and pulses can deliver better results over other kitchen based feeds.

Advantages of Malting:
• Good Digestibility.
• Easy To store.
• Better Hygiene.
• Easily Miscible
Guidelines to Ponder while making formula feeds
• Use measuring cups and spoon to make kitchen feed.
• Utensil and the containers used for feed preparation should be thoroughly cleaned before and after every feed to avoid microbial contamination.
• Standing time of the feed should not be more than 1 hours at room temperature.
• The temperature of the feed should be luke warm to room temperature at the time of administration.
• Any feed before administration should be blended and strained to avoid clogging of tubes.
• Salt and sugar can be added separately as per the doctor’s prescription to maintain osmolality.
• The consistency of the feed should be modified depending on the fringe size of tube. For PEG and PEJ thick feeds can be administered.
• Cooking oil can be added to each feed to enhance calorie intake.