Brief Answer:
His formula may be the culprit

Detailed Answer:
Welcome to HCM!

You didn't mention his feeding regime. Concentrating his formula may make him dehydrated. I would like to see your husband on a lactose free solution. If it is milk based now, switch to soy based and again, no lactose.

His feeding should have been calculated to include so much water per can of formula. Could you please tell me what you are giving him, how often, how are you providing it (tube, oral). Tell me also the calories per ml and the amount of protein per can, your husband's height, weight and if he consumes any other calories than from his tube feeding.

I will give you more specific advice once I have more information from you.

Thank you for coming to HCM. XXXXXXX Shattler, MS,RDN

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Brief Answer:
yes, you may concentrate the formula

Detailed Answer:
It looks like you are feeding him several times per day. You can take him up to a 2.0 kcal formula, take him off fiber for a while to see if he tolerates formula better.

Keep up with flushing the tube 30 ml before and 30 ml. after.

Assure that the water he his missing from concentrated calories be made up by separate water flushes. Generally 1cc of fluid per calorie given throughout the day is a rule of thumb

Keep him elevated during feedings and two hours after. Infuse syringe slowly if not on pump, infusing too quickly will cause gas and bloating.

I hope I have answered your question. Write back if you need more clarification. XXXXXXX Shattler,MS,RDN

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Brief Answer:
He is having signs of tube feeding intolerance

Detailed Answer:
Your husband needs his entire tube feeding feed regime re-evaluated. Below you will find an example of how we will have to re-evaluate calories, fluid protein and timing of feeding.Begin to record weight fluctuations if you can, usual body weight, hydration status, labs, actual caloric intake, protein intake, fluid intake, and route of administration.

I am operating under the assumption you are doing g-tube syringe feeds. Am I correct?

With regards to Nexium, it should be dissolved in a small amount of acidic juice and administered via syringe slowly through the g-tube two hours before an enteral feed first thing in am while sitting up. You never clarified syringe or gravity feed via g-tube, but that is what is sounds like without all clinical information. All g-tube feedings need to be done with water flushes and slow, steady infusion. Infusion too quickly will contribute to tube feeding intolerance, which his symptoms indicate.

I would also administer the Domperidone before the am feed after you have administered Nexium and waited the time to clear the stomach.

Two hours after the Nexium infusion, you may over 20 minutes infuse his next feeding which appears to be the 200 cc Foritsip - make sure you are getting the age appropriate formula as there is a fortisip for 12 year olds.

Fiber slows gastric emptying. Client is being given medication to speed it up. Illogical to add fiber with medication contradicting action of fiber.

I reviewed the Nutrison products and have no problem with the product. Let us first look to see at over-feeding: 380 cc of 1.5 cc formula = 780 calories plus 570 calories of 1.5 cc formula mid-day plu 488 kcals from 200 cc Fortisip =1,578 calories or so without adding in what appears to be 488 calories of Fortisip. The current needs could only be roughly calculated without height, weight, weight changes and usual body weight. I estimated that he needs around 1620 kcalories and is receiving 1848. I doubt without further information that he needs less than 1848, but would need to do a comprehensive assessment. Overfeeding may lead to tube feeding intolerance. Thus, I changed my mind on calorie concentration without further monitoring first.

Water flushes will need to be scheduled so that he receives an additional 800-1500 cc additional fluid depending on his final protein intake and kidney function. Again, slow separate feeding. Don't ever force. Monitor for dehydration via cc of urine or if no catheter, color of urine and skin pinch test, blood tests from doctor. That is, if we concentrate his feedings further. Let us try to not increase above 1.5 kcalories per cc and just get rid of the fiber for right now is my final consideration at this point and monitor fluid and bowel habits.

Did this give you a clearer idea?
1.Give medication on empty stomach with acidic juice;wait two hrs. before feeding- Nexium;2.Give Domperidone prior to first feeding; 3. Take fiber out; 4.Monitor hydration, bowels dehydration 5. No other changes in calories yet; 6. May continue with tea alone without formula and monitor,inform doctor of possibility for serotonin syndrome should antidepressant be added;7.Further problems, have tube feeding totally recalculated;8.don't feed two hours prior to bedtime due to possible reflux problems;9.feed slowly;10.make certain tube not leaking,patency good11.Contact health professional in emergency.

Thank you for telling me about the St. John's Wort. My drug-nutrient interaction book does not show any warning signs - give as a water type flush, not with formula if you give it. If doctor adds antidepressant you will have to discontinue this product.

Thank you for coming to HCM. It has been a pleasure working with you. XXXXXXX Shattler, MS,RDN

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