Validation of a new method for estimating resting energy expenditure of non-ambulatory tube-fed patients with severe neurodevelopmental disabilities

Long-Term Enteral Nutrition Support and the Risk of Dehydration

Dehydration is a serious risk for the long-term tube-fed patient who is not allowed oral intake, has an altered mental status, is unable to communicate, is elderly or fluid-restricted, or has thirst impairment. The intent of this review is to provide a case-based discussion regarding the evaluation, treatment, and prevention of dehydration in these types of patients. Identification of risk factors, along with evaluation of subjective, objective, and laboratory parameters, provides the basis for clinical evaluation. "Hidden" sources of fluid intake such as the water content of solid foods and water generated from nutrient oxidation and "hidden" sources of fluid output such as evaporative losses should be considered in waterbalance calculations. The method for treatment and prevention of dehydration depends on the presence or absence of hypovolemia, type of body fluid losses, and whether the patient demonstrates hypernatremia, normonatremia, or hyponatremia.

Energy requirements of non-ambulatory, tube-fed adult patients with cerebral palsy and chronic hypothermia

OBJECTIVES

We investigated the energy requirements of non-ambulatory patients with severe neurodevelopmental disabilities and chronic hypothermia.

METHODS

Six adult patients with a permanent ostomy for tube feeding were studied. Otic temperature was taken before the indirect calorimetry measurements. Prescribed tube-feeding intake and nutrient prescription changes were evaluated for 4 y for each patient. Monthly body weights and periodic anthropometric body fat assessments were measured for assessment of the need for weight gain, loss, or maintenance. The prescribed caloric intake was compared with the measured energy expenditure when normothermic, the Harris-Benedict equations, and the Arlington Developmental Center equation for non-ambulatory adult patients with severe neurodevelopmental disabilities (estimated resting energy expenditure [kcal/d] = [22.3 x fat-free mass [kg]] - [9.4 x age [y]] + 557).

RESULTS

Mean energy expenditure was 783 +/- 81 kcal/d or 29.0 +/- 10.9 kcal. kg(-1)d(-1) when normothermic versus 606 +/- 11 kcal/d or 19.5 +/- 8.5 kcal. kg(-1)d(-1) (P < 0.05) when hypothermic (36.9 degrees C +/- 0.4 versus 35.5 degrees C +/- 0.4; P < 0.02), respectively. Prescribed caloric intakes to achieve weight gain, maintenance and loss were 138 +/- 13%, 105 +/- 15%, and 74 +/- 11% of the measured energy expenditure when normothermic (P < 0.001); 107 +/- 19%, 86 +/- 18%, and 56 +/- 3% of the Harris-Benedict equations (P < 0.02); or 130 +/- 23%, 100 +/- 19%, and 75 +/- 11% of the Arlington Developmental Center equation (P < 0.02).

CONCLUSIONS

Measured energy expenditure when the patient is normothermic significantly overestimated actual caloric needs. The energy intake necessary to achieve desired weight changes are restrictive when compared with the basal energy expenditure, Arlington Developmental Center equation, or measured energy expenditure when normothermic.