Hyperalimentation

Definition

Hyperalimentation can be defined as the administration of an increased quantity of nutrients, exceeding the appetite demands. This term is used incorrectly, as the parental hyperalimentation does not actually provide the body with increased quantities of nutrients. The hyperalimentation is used in patients who cannot eat food on their own or in those who suffer from nutritional deficiencies.

Types

Intravenous hyperalimentation

The intravenous administration of nutrients is recommended for patients who cannot ingest food through the alimentary tract. The nutrients, along with electrolytes, are administered into the central veins, through the usage of a catheter. The intravenous hyperalimentation is often used in those who are anorexics, with the purpose of re-feeding them.

Parenteral hyperalimentation

The parenteral administration of nutrients is recommended for patients who present different gastric dysfunctions. Parenteral hyperalimentation is chosen for all patients who suffer from various other medical problems, which may impair the gastrointestinal absorption (threatening their existence). This method of alimentation might also be chosen in patients who have undergone surgery, so as to prevent severe malnourishment.In the situation that the total parental nutrition is chosen, a central venous catheter is going to be implanted into the vena cava or the right atrium. The solution that is administered daily includes electrolytes, vitamins, amino acids, glucose, minerals and sometimes fats (generally known as a hypertonic solution). Depending on the nutritional needs of the patient, the solution might be infused intermittently, overnight or throughout the entire day.The parenteral hyperalimentation remains the first line of choice for patients who cannot benefit from tube feedings, due to the existence of a severe pathology at the level of the gastrointestinal tract. Among the conditions for which parental hyperalimentation is recommended, there are: Crohn’s disease, obstruction (stricture or neoplasm of esophagus/stomach), disorder of the central nervous system (the patient is not able to swallow and there is a high risk of aspiration), short bowel syndrome (appears after a massive resection of the bowel), malabsorption caused by different types of fistulas (enterocolic, enterovesical or enterocutaneous), motility disorder (this is known as a pseudo-obstruction), prolonged paralytic ileus (after a serious surgical intervention or in case of injury), newborns with anomalies at the level of the gastrointestinal tract, systemic diseases affecting infants and small children. Wasting is also considered an indication for parenteral hyperalimentation.Total parenteral hyperalimentation has been chosen as a method of feeding for comatose patients as well. In the past few years, however, for these patients doctors have started to recommend the enteral feeding (due to the reduced complications).

Enteral hyperalimentation

The enteral hyperalimentation is recommended in patients who are suffering from severe medical problems, such as cancer or those who present a breathing stoma. The patient is fed through a gastrointestinal tube.In the situation that a person suffers from disorders of the pharynx, esophagus or stomach, the intake of nutrients being prevented, the enteral hyperalimentation is prevented. The individuals that are fed through this method still have their intestinal tract functioning. There are different types of tubes that can be used for the enteral hyperalimentation, such as: nasogastric, gastrostomy, jejunostomy or percutaneous endoscopic gastrostomy tubes. The enteral hyperalimentation can also be used in pediatric patients. Infusion pumps are used in order to ensure the constant flow of the nutrients. Depending on the nutritional needs of the patient, the infusion pump can be continuous or intermittent.The usage of enteral nutrition at home is recommended in patients who are unable to swallow (due to different types of cancer, affecting the head, neck, esophagus or stomach – the obstruction is due to the tumor or a stricture has occurred as a complication of the cancer) and also in those who have been diagnosed with disorders of the central nervous system (the person cannot coordinate enough in order to chew or swallow; plus, there is the risk of aspiration).

Side effects

These are the most common side-effects that can appear with hyperalimentation:

• Mechanical difficulties with the catheter – this can lead to temporary or permanent discontinuation of the intravenous hyperalimentation
• Thrombosis of the subclavian vein
• Sepsis (generalized infection)
• Fluid overload
• Hyponatremia
• Hyperglycemia
• Mouth sores
• Poor night vision
• Changes at the level of the skin
• Heartbeat changes
• The patient might be experiencing confusion or suffer from memory loss
• Convulsions and seizures can occur as side-effects of the parenteral hyperalimentation
• The patient might experience difficulty breathing
• Fever and chills are also present
• Increased urinary output
• The patient’s reflexes are exaggerated
• The patient might suffer from muscular weakness, presenting cramps and muscle twitches
• Pain at the level of the stomach
• The extremities of the body can start to swell (hands, feet or legs)
• The patient might experience intense thirst, nausea or vomiting
• The patient can describe a tingling sensation in the hands or feet.

Apart from the side-effects, one must be aware that the hyperalimentation comes with a series of risks. One of the most common risks, regardless of the method of hyperalimentation, is the one of infection (the catheters that are used for hyperalimentation can get easily infected). Other risks include the formation of blood clots, which can travel to the brain, leading to cerebrovascular stroke.It is important to understand that, even though hyperalimentation can be performed at home, it still has a major impact over the quality of life. However, the majority of the patient prefer that they receive the hyperalimentation at home, rather than stay in the hospital. For the patient, it is essential that not many major changes are made, so as to reduce the risk of depression and anxiety. The patients are encouraged to stay as physically active as they can, avoiding intense physical exercise. A physical therapist can be of tremendous help in determining the exact amount of physical exercise one is allowed to perform. Moreover, the physical therapist can perform passive stretches in patients who cannot move, reducing the risk of pressure sores and other complications. For the patients who are going through the recovery period, physical therapy can also be helpful in progressing from the lying position to the sitting and eventually to standing.