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Every patient receiving enteral or parenteral nutritional support should be monitored closely. Formal nutritional support teams composed of a physician, a nurse, a dietitian, and a pharmacist have been shown to decrease the rate of complications.

Patients should be monitored both for the adequacy of treatment and to prevent complications or detect them early when they occur. Because estimates of nutritional requirements are imprecise, frequent reassessment is necessary. Daily intakes should be recorded and compared with estimated requirements. Body weight, hydration status, and overall clinical status should be followed. Patients who do not appear to be responding as anticipated can be evaluated for nitrogen balance by means of the following equation:

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Patients with positive nitrogen balances can be continued on their current regimens; patients with negative balances should receive moderate increases in calorie and protein intake and then be reassessed. Monitoring for metabolic complications includes daily measurements of electrolytes; serum glucose, phosphorus, magnesium, calcium, and creatinine; and BUN until the patient is stabilized. Once the patient is stabilized, electrolytes, phosphorus, calcium, magnesium, and glucose should be obtained at least twice weekly. Red blood cell folate, zinc, and copper should be checked at least once a month.

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Bally  MR  et al. Nutritional support and outcomes in malnourished medical inpatients: a systematic review and meta-analysis. JAMA Intern Med. 2016 Jan 1;176(1):43–53.
[PubMed: 26720894]  
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Lewis  SR  et al. Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Jun 8;6:CD012276.
[PubMed: 29883514]  
+
McClave  SA  et al. ACG Clinical Guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol. 2016 Mar;111(3):315–34.
[PubMed: 26952578]  
+
McClave  SA  et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016 Feb;40(2):159–211.
[PubMed: 26773077]
+
Parikh  HG  et al. Calorie delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care Resusc. 2016 Mar;18(1):17–24.
[PubMed: 26947412]  
+
Reintam Blaser  A  et al; ESICM Working Group on Gastrointestinal Function. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017 Mar;43(3):380–98.
[PubMed: 28168570]  
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Shi  J  et al. Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: a systematic review and meta-analysis. Medicine (Baltimore). 2018 Oct;97(41):e11874.
[PubMed: 30313021]  

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