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Calculate enteral nutrition requirements and feeding rates for tube-fed patients
Energy: Mifflin-St Jeor × Activity × Stress
Protein: 1.2-1.8 g/kg based on stress level
Fluid: 30 mL/kg/day
24-hour infusion. Best for critically ill, jejunal feeding, gastroparesis. Better tolerance, less aspiration risk.
4-6 feedings over 30-60 minutes. More physiologic, allows mobility between feedings. Gastric feeding only.
6-8 rapid feedings (15-30 min). Most physiologic, convenient. Only for gastric feeding with good GI function.
| Formula Type | Density | Protein | Indications |
|---|---|---|---|
| Standard Polymeric | 1.0 cal/mL | 40 g/L | Normal GI function, general nutrition |
| High Calorie | 1.5-2.0 cal/mL | 60-75 g/L | Fluid restriction, high energy needs |
| High Protein | 1.0-1.2 cal/mL | 60-75 g/L | Wound healing, critical illness, sarcopenia |
| Diabetic Formula | 1.0 cal/mL | 45 g/L | Diabetes, hyperglycemia (low carb) |
| Renal Formula | 2.0 cal/mL | 70 g/L | Renal failure (low electrolytes, fluid restricted) |
| Elemental/Peptide | 1.0 cal/mL | 38 g/L | Malabsorption, short bowel, pancreatitis |
| Immune-Enhancing | 1.0-1.3 cal/mL | 55-80 g/L | Surgery, trauma (arginine, omega-3, glutamine) |
Prevention: Elevate HOB 30-45°, check residuals, consider post-pyloric feeding if high risk.
Causes: Too rapid advancement, antibiotics, contamination, hyperosmolar meds. Slow rate, fiber formula, probiotics.
Increase water flushes, fiber formula, mobilization. Rule out obstruction if severe.
Risk in malnourished. Monitor phosphorus, potassium, magnesium. Start at 25% goal, advance slowly over 3-5 days.
Prevention: Flush with 30 mL water every 4 hours, before/after meds. Liquid medications when possible.
Start at 25% of goal rate for continuous feeding or 25% of goal volume for intermittent/bolus. Advance by 25% every 4-8 hours as tolerated. In malnourished patients at risk for refeeding syndrome, advance even more slowly over 3-5 days. Monitor electrolytes closely.
Residuals <500 mL are generally acceptable. Don't automatically hold feeds for residuals 200-500 mL; assess for other signs of intolerance (nausea, vomiting, distension). Return residuals to stomach. Consider prokinetic agents if persistently high. Very high residuals (>500 mL) or increasing trend warrant intervention.
Indications: High aspiration risk, severe gastroparesis, recurrent vomiting, pancreatitis, or high gastric residuals. Jejunal feeding requires continuous administration (not bolus). May have better tolerance but more difficult to place and maintain.
Flush with 30-60 mL water every 4 hours, before and after medications, and before and after checking residuals. Total free water needs are approximately 30 mL/kg/day minus water content of formula (standard formula is ~75-85% water). Adjust based on fluid balance and labs.
Common causes: Too rapid advancement, antibiotics, contaminated formula, hyperosmolar medications, C. difficile. Management: Slow rate, ensure proper formula handling, switch to fiber-containing formula, give medications diluted, consider probiotics, rule out infectious causes. Don't automatically stop feeds.
When patient demonstrates safe swallow (may need swallow study), adequate oral intake (>50-75% needs for 3-5 days), and sustained nutritional improvement. Transition gradually: reduce tube feeds as oral intake increases. Maintain tube initially as safety net. Remove tube once oral intake consistently meets nutritional needs.
This tube feeding calculator provides estimates for educational purposes only. Actual nutrition requirements vary based on individual patient factors, medical conditions, and metabolic status. All enteral nutrition prescriptions must be determined and monitored by qualified healthcare professionals including physicians, registered dietitians, and nutrition support teams. Regular monitoring of tolerance, metabolic parameters, and nutritional status is essential. This tool should not replace comprehensive nutrition assessment or clinical judgment.