Thursday, November 5, 2009

Medical nutrition products choice and lab value..

Ada orang yang bertanyakan saya tentang apa kaitan general biochemical result dan pilihan penggunaan medical nutrition products tertentu. Saya ingin mengambil contoh yang mudah iaitu nak pilih Ensure atau Nutren Optimum. Kedua-dua produk ini dikenali sebagai general standard medical nutrition product for adult. Boleh digunakan sebagai sole nutrition, oral nutrition supplement, or replacement. Secara umumnya kedua-dua boleh dipilih….namun cuba tengok kes simple ni….

Katakanlah seorang pesakit yang fully dependent on tube feeding dan calorie requirement for him ialah 1800 kcal/day

To achieve the requirement, pt. need app. 47 ½ scoop of Ensure or 50 scoops of Nutren Optimum. It means that, if we give 47 ½ of Ensure, we at the same time feed pt with 2802.5 mg of potassium (1sc = 59 mg K), or 2200 mg of potassium if Nutren Optimum given (1 sc = 44 mg K). Ensure contains 27% higher amount of Potassium than Nutren Optimum.

So in the long term, pt on Ensure is given more potassium. Potassium in high amount for long term without monitoring can cause other serious medical conditions. It is more vulnerable for unconscious pt or pt having cardiac or renal problem.

So we can conclude that, at the same amount of calorie given, beware of nutritional product given. Ensure preferable should not be given for patient who has marginal or high level of potassium blood level and blood level is better monitored. If there is no choice, try to shorten the usage of it.

From my experience, I can see that potassium level for vulnerable pt. is increasing. At the same time, Abbott product seems to contain higher amount of potassium compared to other competitors.

In general, as conclusion, other factor that must be bear in mind during deciding suitable medical nutritional product is general biochemical result. More caution must be taken when patient has ‘abnormal’ lab test or pt. had other medical problem. Ok? Adakah penjelasan saya ini merungkai persoalan yang ditanya?

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