What type of formula is Isosource HN? What are the percentages of ...

[Mr. Wonderful]

What type of formula is Isosource HN? What are the percentages of kilocalories from carbohydrate, protein, and lipid? Is there a specific nutrient composition that should be considered in respiratory failure or the mechanically ventilated patient?
 
  What will be an ideal response?

Question 2

Gluten restriction is the major component of the medical nutrition therapy for celiac disease. What is gluten? Where is it found?
 
  What will be an ideal response?

Question 3

A nutrition consult was completed on 3/27, and enteral feedings were initiated. Mr. Hayato was started on Isosource HN  25 cc/hr continuously over 24 hours.
 
  What will be an ideal response?

[bbburns21]

Answer to Question 1

 Isosource HN is a high-nitrogen, standard tube-feeding formula
 Protein: 18; carbohydrate: 53; fat: 29
 It has been found that patients fed a pulmonary formula did not have any significant difference in their outcome from those fed a standard formula in amounts slightly less than their estimated or measured requirements.
 The NCM states that the routine use of high-fat and low-carb formulas for pulmonary patients is not warranted

Answer to Question 2

 Gluten is a term for all of the prolamin protein components including: gliadin, hordein, and secalin, found in the grains of wheat, barley, and rye, respectively.
 This means any food containing wheat, rye, or barley must be eliminated from the diet.
 Convenience foods or any commercial products that use thickeners or fillers made from these grains cannot be consumed either (ex: hot dogs, French fries, Communion wafers, gravy, candy, malted products, and beer). In the US, most thickeners or fillers use corn rather than wheat but it is also important to assure safety.

Answer to Question 3

a. At this rate, how many kcal and grams of protein should he receive per day?

 Isosource HN provides 1.2 kcal/mL and 0.0536 g protein/mL (18 total kcal).
 25 cc/hr provides 720 kcal and 32 g protein.

b. Calculate his nutrition prescription utilizing this enteral formula. Include the goal rate, free water requirements, and the appropriate progression of the rate.

 Goal rate would be 56 cc/hr, which would provide 72 g protein, 1613 kcal, and 1344 mL of formula .
 Isosource HN contains 818 mL water per L, so 1344 mL of formula would provide 1099 mL of water.
 Using 1600 mL as his fluid requirements, he will need an additional 500 mL of water.
 The rate should be progressed by 10 mL/hr for every 8 hrs. This lower rate of progression may help as he appears to have gastric emptying issues.