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Nutritional Issues
- 87% of hematology patients lose weight during the course of illness
- 20% die as a result of malnutrition
- Nutritional deterioration is associated with poor response to treatment, higher complication rates, longer hospitalizations,greater disabilities and higher overall costs of care
- Causes of malnutrition
- Decreased oral intake due to anorexia/ vomiting
- Increased energy requirement
- Malabsorption due to mucositis/ diarrhea
- Loss of nutrients from gut
- General instructions:
- Avoid large meals. 6 smaller meals are better tolerated.
- Drink liquids in between meals
- Keep high calorie and high protein snacks on hand such as ice cream, dry fruits, cheese etc
- Avoid consuming empty calories food such as soda and fast food
- Light exercise to stimulate appetite
- Add high calorie, high protein such as butter, skimmed milk powder, honey etc
- When there is mucositis avoid citrus foods, spicy foods etc. Instead consume bland, soft textured foods such as payasam.
- Dietary education and counseling. Therapeutic diet to meet individual patient's needs.
- Neutropenic diet
- Typically limits consumption of fresh fruits, raw vegetables, aged cheeses, cold meat cuts and fast food
- Curds and buttermilk are restricted
- Food should be freshly cooked
- Pharmacological measures: Include corticosteroids, cannabinoids, hydrazine, RC-1291-Ghrelin mimetics, thalidomide
- Feeding through nasogastric tube
- Start with 25ml/hr
- Head end of bed to be elevated by 30 degrees to avoid regurgitation
- Use prokinetics: Metoclopramide 10mg IV 6th hourly
- Total parenteral nutrition
- Administered prophylactically irrespective of nutritional status and adequate oral intake.
- All in one solution: 1bag/ day
- Patients must have central venous access catheters, if TPN is being administered.
- It allows better modulation of fluid, electrolyte and nutrient administration.
- Indications
- Severe malnutrition at admission
- Prolonged (7-10 days) minimal oral intake
- Clinical weight loss exceeding 10% during treatment
- Severe mucositis, ileus or intractable vomiting.
- TPN is given generally for 15-20 days.
- Amino acid dose in TPN- 1.5-2gm/Kg/day
- Mixture of long chain and medium chain fatty acids are often added. Some centers avoid TPN with lipids, as lipids are not needed in acute phase, it can induce macrophage activation and may pose problems with indwelling lines.
- TPN can induce transaminitis and hyperbilirubinemia. Urso deoxycholic acid may be used in such situations. Glutamine supplemented TPN is useful in preventing gut GVHD.
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