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Recommendations of Berry and Fischer for Nutrition in a Patient with an Enterocutaneous Fistula

Description

Many patients with an enterocutaneous fistula will develop malnutrition, which will affect the patient's chances of fistula closure. Berry and Fischer listed recommendations for the nutritional support for these patients. The authors are from the University of Cincinnati.


 

Parameters:

(1) output from fistula

(2) preferred route of nutrition

(3) total calorie requirement

(4) protein requirements

(5) lipid requirements

(6) minerals and electrolytes (magnesium, potassium, sodium, bicarbonate, zinc)

(7) vitamins

Output in mL per Day

Severity of Fistula

< 200 mL/day

low output

200 - 500 mL/day

intermediate output

> 500 mL/day

high output

 

 

Parameter

Low Output

Intermediate Output

High Output

route

enteral

enteral

enteral, may require parenteral for part or all

total calories

resting energy expenditure (REE)

1.25 * REE

1.5 * REE

protein

1.0 - 1.5 g/kg/day

1.25 - 2.0 g/kg/day

1.5 - 2.5 g/kg/day

lipid

20-30% of total

20-30% of total

20-30% of total

minerals

not a problem

monitor

monitor

vitamins

RDA, increased vitamin C

1.5 times RDA, increased vitamin C

2 times RDA

 

where:

• Calculation of protein requirements in the implementation is based on ideal body weight, since this would prevent problems from excessive weight loss or obesity.

 


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