enteral formula for chylous situations

Q: Which of the following enteral formula may be useful in chylothorax or chylous ascites? 

A) Standard
B) Concentrated 
C) Predigested
D) Patient should be kept NPO
E) Only nocturnal enteral nutrition 


Answer: C

Predigested enteral nutrition is also known as a semi-elemental or elemental formula. The main focus in this formula is on decreased fat with increased medium-chain triglycerides (MCTs). Also, the protein is hydrolyzed to short-chain peptides and a less complex form of carbohydrate is included. MCTs can't enter lymphatic capillaries in the small intestine and are advocated in patients with thoracic duct leak, chylothorax or chylous ascites. They are also recommended in malabsorptive syndromes, short gut syndromes, unresponsive gut to pancreatic enzymes supplements, and persistent diarrhea from standard enteral nutrition in ICU. As the name implies, they are like a digested form of enteral nutrition and better tolerated by the digestive system.

Abovesaid, evidence for its regular use in ICU is still weak.


References:

Seres DS, Ippolito PR. Pilot study evaluating the efficacy, tolerance and safety of a peptide-based enteral formula versus a high protein enteral formula in multiple ICU settings (medical, surgical, cardiothoracic). Clin Nutr 2017; 36:706.