Search

Adequate nutritional support is an important aspect of the care of all patients. Enteral nutritional support accesses the gastrointestinal tract and includes both oral supplementation and tube-feeding techniques. Enteral nutritional support should be considered when a patient has functioning intestines but cannot or will not eat. Most patients require a caloric intake of 25 to 35 kcal per kg per day. The choice of route of administration for tube feedings should be based primarily on the anticipated length of therapy and patient comfort. Three schedules for the initiation and delivery of tube feedings are presented in this article. Both nasogastric and percutaneous endoscopic gastrostomy tubes are associated with potential complications, including aspiration and gastrointestinal intolerance. Important parameters include the patient's weight and volume status, and periodic laboratory determinations of the patient's serum electrolytes and protein status.

Although immunization practices have dramatically reduced the incidence of measles, several populations remain at risk of the disease. Modified measles may occur in those who received immune globulin in childhood. Atypical measles, often confused with Rocky Mountain spotted fever, may develop in those who received inactivated measles virus vaccine and were subsequently exposed to the natural disease. The diagnosis of measles requires a high index of suspicion and a careful immunization history.