Clin Nutr Res.  2017 Oct;6(4):306-309. 10.7762/cnr.2017.6.4.306.

Continuation of Enteral Nutrition and Relief from Vomiting by Administration of a New Formula: a Case Report

• Akashi T
• Matsumoto
• Hashimoto

• KMID: 2392794
• DOI: http://doi.org/10.7762/cnr.2017.6.4.306

Abstract

Gastro-esophageal reflux (GER) is a common and serious complication in patients receiving enteral nutrition, making continuation of enteral nutrition difficult. Semi-solid enteral nutrients were developed to prevent feeding-related GER. Semi-solid enteral nutrients have high viscosity and, therefore, are typically administered through a large-diameter percutaneous endoscopic gastrostomy (PEG) tube. Recently, a new formula (Mermed®, Mermed Plus®) was introduced that uses alginate, which behaves like a gelatin in acidic conditions. This formula improved GER during enteral feedings. Our case report shows that this new formula enables the continuation of enteral nutrition via a nasogastric tube (NGT) in patients with difficulty tolerating enteral nutrition secondary to vomiting. An 86-year-old woman with an atherothrombotic cerebral infarction vomited during tube feeding, resulting in aspiration pneumonia. After 1 week, we introduced a viscosity regulator and restarted enteral feeding using a 100 mL liquid diet, but vomiting persisted. Because of the continued difficulty in tolerating enteral nutrition, the patient was transferred to our hospital. From hospital day 4, Mermed Plus® (300 mL/225 kcal, administered for 1 hour, 3 times a day) was started, eventually increasing to 535 mL/400 kcal at hospital day 5. After this, vomiting ceased. Mermed Plus® was easily administered via NGT, and its effects were immediate. This treatment appeared to improve the patient's quality of life while reducing the burden on medical staff.

Keyword

Enteral nutrition; Gastroesophageal reflux; Viscosity; Alginates

MeSH Terms

Aged, 80 and over
Alginates
Cerebral Infarction
Diet
Enteral Nutrition*
Female
Gastroesophageal Reflux
Gastrostomy
Gelatin
Humans
Medical Staff
Pneumonia, Aspiration
Quality of Life
Viscosity
Vomiting*
Alginates
Gelatin

Figure

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  Figure 1 The patient's clinical course. PEG, percutaneous endoscopic gastrostomy; REF-P1, a viscosity regulator (Kewpie Corporation, Tokyo, Japan).

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