Answer to Question 1
Currently, arginine supplementation is not suggested in sepsis and negative outcomes have been documented with its use. There is some controversy in the literature regarding the use of glutamine for critically ill patients as the studies have studied glutamine both enterally and parenterally in a variety of critically ill populations and in a combination with other nutrients. It is likely that the controversy lies with these differences in research design and in the populations that were studied. Previous trials noted benefit of glutamine supplementation. Omega-3- fatty acids and antioxidants should be considered in patients with acute lung injuries or adult respiratory distress syndrome. Otherwise, more research is needed in regards to other critical illnesses, such as sepsis, since negative and potentially harmful outcomes may occur the literature needs to continue to clarify its use.
Answer to Question 2
At the beginning of the postoperative phase for patients with a colostomy the gradual incorporation of fruits/vegetables/whole grains is suggested. This begins will consuming only low-fiber options, initially.
Soluble fibers (e.g. applesauce, bananas, rice) may help thicken the stools and prevent loose/watery stools
Use of yogurt, parsley, and buttermilk may decrease gas and odor
Foods that may cause gas (e.g. broccoli, eggs, asparagus), obstruction, or diarrhea should be avoided,initially
Over time the bowel will adapt and begin to form more solid stools (this may take several months).
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For patients with an ileostomy, fat malabsorption, lactose intolerance and fluid balance may be problematic. With more of the ileum removed, B12 malabsorption is more likely and supplementation may be needed.
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