Disease-Specific Nutrition Support and Transitions of Care
Disease-specific considerations
Critical illness: early EN within 24-48 hours when feasible, avoid overfeeding, use indirect calorimetry when available. Acute pancreatitis: EN (nasogastric or nasojejunal) is preferred over PN when tolerated; severe cases may need PN if EN fails. Liver disease: avoid protein restriction in encephalopathy; protein needs are often increased. Renal failure: protein intake depends on dialysis status; dialysis patients need higher protein. Diabetes: glycemic control matters more than formula type. Obesity: hypocaloric high-protein feeding may be appropriate. Short bowel: gradual advancement, consideration of trophic factors, and long-term PN in some cases.
Transitions of care
Discharge planning should address who manages the tube or catheter, who monitors labs, how to obtain supplies, and when follow-up occurs. Transition from PN to EN or oral diet should be gradual with monitoring. Home PN requires trained caregivers and clear emergency plans.
Traps
Questions often test that protein restriction is not appropriate for hepatic encephalopathy, that EN is preferred in pancreatitis when feasible, and that dialysis patients need more protein, not less.
Worked rule of thumb
For a hemodialysis patient, protein needs are typically 1.2-1.3 g/kg/day or higher - higher than for non-dialysis chronic kidney disease, where lower protein may be used.