Artificial Nutrition and Hydration: Benefits and Risks
Under normal conditions, we obtain our nutrients and fluids orally. But when a medical problem prevents this usual intake, we must opt for other ways to obtain them. In this case, we’re talking about artificial nutrition and hydration, which replace food as a source of nutrients.
In particular, it works for many types of patients, such as those with temporary medical problems who have lost fluids through vomiting, sweating, or diarrhea. It’s also useful for people with advanced life-threatening illnesses. What are its benefits and risks? Here are the details.
What’s artificial nutrition and hydration?
As Dr. Diana Ramos explains, almost 60% of our body is water. Most of it is used to dissolve and transport the different nutrients that have specific functions in the body. For this reason, daily consumption of food and beverages is a determining factor in maintaining a healthy body.
Artificial nutrition and hydration is an intervention that provides everything the body requires, but by different means than usual. It’s nutritional support that doesn’t require the patient to chew or swallow. Instead, probes or tubes are used that go from the mouth to the digestive tract, or catheters directly into the veins.
The MedlinePlus website explains that this type of nutrition is for people who don’t receive enough nutrients or fluids through regular meals. There may be severe malnutrition, swallowing difficulties, appetite problems, or poor absorption of nutrients in the digestive tract.
Types of artificial nutrition and hydration
The types of artificial nutrition and hydration are divided into 2 main categories, enteral and parenteral. In the following paragraphs, we’ll share their main characteristics.
Enteral nutrition is a nutritional support technique that consists of administering nutrients directly into the gastrointestinal tract through a tube. It’s indicated in cases where the person requires individualized nutritional support and doesn’t ingest the necessary nutrients to cover his or her needs.
It’s generally applied in the following cases:
- Premature babies
- Burn victims
- Patients who can’t swallow
- Hemodynamic alterations such as cardiopathies
Depending on the route of administration of the formula to be given, and the objectives of the same, the following forms of enteral nutrition can be considered:
- Nasogastric tube: Used when enteral nutrition is of short duration. Doctors insert an NG tube through the nose and down the throat into the stomach. If the stomach doesn’t tolerate it, they can pass it down to the small intestine.
- Gastrostomy: Used when the nutrition program has to last for more than 4 weeks. In this case, doctors insert a tube by direct surgical procedure into the stomach. The most common is the percutaneous endoscopic gastrostomy or PEG tube.
- Jejunostomy: Follows the same procedure as gastrostomy, only the tube goes directly into the small intestine or jejunum.
The Spanish Association of Pediatrics describes parenteral nutrition as nutrition that delivers nutrients or fluids through a very small catheter or tube placed in a vein in the body.
Medical staff can place a catheter in a peripheral line in the lower arm, or in a central line that’s closer to the heart. There are two types to consider:
- Total parenteral nutrition or TPN: When it constitutes the only nutrient supply.
- Partial parenteral nutrition: When it provides only a complement to the enteral supply.
In general, doctors prescribe it to prevent or correct the adverse effects of malnutrition in patients who are unable to obtain sufficient oral or enteral intake for a period of more than 5 or 7 days.
It shouldn’t last for periods of less than one week and should continue until the patients achieve an adequate transition to enteral feeding.
What is given to a person by artificial nutrition and hydration?
The journal Nutricion Hospitalaria states that the nutrients and fluids depend on the type of procedure and, above all, on the needs and conditions of each patient.
- Enteral feeding tubes: Can deliver water, liquids, special liquid diets or formulas, and pureed foods.
- Parenteral nutrition: The nutrients must be in a very simple form, as they go directly into the blood. They should produce energy and maintain weight. Fluids, electrolytes, amino acids such as taurine and cysteine, carbohydrates such as glucose, fatty acids, minerals, and vitamins are indicated.
- Parenteral fluids are a solution of water with salt and sugar. They may also contain other substances such as minerals.
What are the risks of artificial nutrition and hydration?
The risks also vary depending on the administration procedure. That is, whether it’s enteral or parenteral.
A nasogastric tube can cause choking and discomfort during or after placement. Likewise, when inserted, it can become misplaced in the trachea, causing pneumonia.
The tube can cause erosions, abrasions, and perforation of the nasal passages, esophagus, and stomach, causing acute or chronic bleeding occurs. Restraints are sometimes necessary to prevent the tube from coming out. It can also cause psychological distress, increased agitation, and anxiety.
Gastrostomy tubes require anesthesia during placement and, therefore, there are risks having to do with anesthesia. Abdominal wall infection and peritonitis may occur. They may also cause gastrointestinal bleeding, obstruction, or perforation of the bowel. In turn, there’s a risk of diarrhea from formula and aspiration pneumonia.
Catheters used in total parenteral nutrition can cause infection and even sepsis. A collapsed lung is possible at the time of catheter insertion. Also, clots can travel to the brain or lungs, which endangers the patient’s life.
Other clinical manifestations include irregularities in the heartbeat and electrolyte disturbances, such as low levels of potassium and sodium. Blood sugar can reach very low levels.
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Localized infection may occur or a skin infection that could spread. Thrombophlebitis, or clotting in the vein, with swelling and discomfort, is another type of complication that occurs with some frequency. Fluid overload may cause swelling of the legs, arms, and body. Low sodium or potassium levels are common.
What to remember?
Artificial nutrition and hydration is a medical approach with beneficial effects for the patient who requires it. However, the decision for its use should be based on medical prescription, as it has many side effects and associated complications.It might interest you...