Artificial Feeding

ARTIFICIAL FEEDING. a) 300 g of milk-tea with milk; b) 500 g of mucilaginous soup of grain, 50-100 g of butter, soluble protein preparation, e.g., lecithin-protein; c) repetition of a. Total per day up to 3000 cal., about 80 g of nitrogenous substances; Feeding through a tube in cases of stagnation in the esophagus or stomach on the basis of stenosis must be preceded by the removal of food residues by siphon washing through a small funnel and relaxation of the spasm, with atropine or papaverine. In glossitis and tonsillitis, introduction of the tube is sometimes tolerated better than swallowing food. On the contrary, in unconscious states, tube feeding is contraindicated due to the danger of aspiration pneumonia (Norden). A special form of introduction of food through a tube is forcible feeding (the so-called gavage of French authors) - in psychoses and in prisons - during hunger strikes. 2. Introduction of the tube through the nose for 40-45 cm is sometimes tolerated better than through the mouth, since this reduces irritation of the pharynx and makes swallowing of the tube unnecessary (e.g., in unconscious states); moreover it is indicated in tumors of the mouth, spasm of the masticatory muscles (trismus) and in premature children. 3. Duodenal feeding: introduction of a thin tube for 70-90 cm several times a day or for a prolonged time, up to 2-3 weeks, according to the proposal of American authors (Einhorn, Lyon, etc.), recommending this method in the treatment of gastric ulcer on the assumption that in this way the diseased organ is supposedly completely immobilized. (See also Duodenal tube.) Indications: a) disorders of swallowing, when introduction of food or a thick tube is impossible; b) state of acute irritation of the stomach (ulcer, hypersecretion) and duodenum; c) complete loss of appetite (in hysteria and other psychoses); d) intractable vomiting, in which the tube is usually tolerated better than food. In Europe this method is still little applied, since according to the majority, the possibility of immobilizing the stomach is doubtful due to the peristalsis and antiperistalsis caused by the tube, and moreover feeding of ulcer patients, even in severe forms, is possible by the normal route. Serious side effects after introduction of the tube are not excluded: pains, heartburn, salivation. Norden described a case of profuse vomiting in an ulcer patient shortly after introduction of the duodenal tube. - Technique. Usually 150-300 cm³ are introduced per dose, not more than 100 cm³ every 5 minutes. Einhorn's scheme: 8 doses per day, total 1600 cm³ of milk, 8 eggs, 120-240 g of milk sugar (103 g of protein, 96 g of fat, 194-314 g of milk sugar = 2100-2600 cal.). From other products - grains and vegetables in the form of powder, gelatin, peptone, meat powder, cocoa, chocolate, honey, almond milk, fish oil. M. Labbe gives 4 times a day 150 cm³ of milk (up to 2 liters per day) through a syringe or funnel. It was proposed for pylorospasm in children to introduce food through a thick tube into the duodenum (Hess). The digestibility of food during duodenal feeding is very high. 4. Feeding through an operative gastric or small intestinal fistula in cases of esophageal (gastrostomy) or gastric (jejunostomy) stenosis. Since in most cases we are dealing with cancerous stenoses, artificial feeding through a fistula is carried out as a palliative measure only in extreme cases, for maintaining the strength of the patient. In the presence of cachexia or the threat of perforation, it is better to completely refuse to create a fistula and resort to nutrient enemas. In benign, and sometimes malignant, stenoses, feeding through a fistula can lead to a significant increase in weight (according to Norden - up to 16 kg in two months). The food must be prepared tasty, with appropriate seasonings. One can even recommend to the patient to chew part of the food and spit it out, in order to preserve the psychical phase of gastric digestion as much as possible. Trendelenburg even proposes that patients "spit" chewed food into their stomach through a tube connected to the fistula. Technique: a) with a gastric fistula 3-4 meals a day of 250-500 cm³; milk, cream, beaten eggs, vegetable and fruit purees with sugar (better milk); later - crushed rusks, finely chopped meat and other well-crushed solid food; b) with a small intestinal fistula feeding is more difficult, since in one dose a very small amount can be introduced, not more than 100-150 cm³, otherwise spasm of the circular musculature of the intestine sets in and the food is thrown out again. Eiselsberg's scheme - 8 doses per day: 1) 300 g of milk, 1 egg; 2) 300 g of milk, 30 g of flour, 1 egg, 2 tablespoons of vegetable oil; 3) 25 g of strong broth (beef-tea), 1 egg; 4) 150 g of broth, 1 egg; 5) 300 g of milk, 1 egg, Nestle; 6) as in 1; 7) as in 4 and 8) as in 1; besides that - nutrient preparations such as riba, tropone, somatose, dextrin, etc.; total per day up to 2200 calories with 125 g of protein. Or the following recipe: 1) 300 g of boiled milk with 20 g of wheat flour, 1 egg; 2) 300 g of bottled broth with 2 spoons of pea flour; 3) 100 g of milk soup and 100 g of bottled broth, 4), 5) and 6) repetition of the first three. 5. Rectal feeding - introduction of food through the rectum - is the oldest and most common method of artificial feeding. In recent years it has been somewhat discredited, since a) the quantity of food substances well absorbed by the rectum is very limited, b) irritation of the intestine (diarrhea, false urges, meteorism) or even infectious proctitis is often observed. Nevertheless, nutrient enemas have a certain sphere of application, mainly in acute irritation of the stomach (intractable vomiting, bleeding from ulcer), in disorders of swallowing, in coma. Absorption of individual food substances in the rectum is extremely variable. Undoubtedly well absorbed is only water, as well as NaCl in isotonic concentration. All hypotonic food solutions (milk, eggs) are absorbed better with the addition of NaCl. Absorption of proteins is possible only with the help of bacterial processes (Norden), since proteolytic enzymes are almost no longer present in the large intestine. Products of protein breakdown (peptides and polypeptides, peptones, albumoses, especially amino acids, e.g., erepton) are absorbed somewhat better, as well as a mixture of meat puree with pancreatic extract (according to Leube) and gelatin. True, all these substances easily irritate the mucous membrane. The digestibility of carbohydrates is also very limited. The question of starch absorption is not yet fully resolved; in any case, dextrin (in dropwise enemas of a 15% solution) and all types of dextrinized flour (Nestle, etc.) are absorbed better. Enemas of sugar have almost no effect on glycosuria, which however does not exclude the fact of absorption, since it is possible that under these conditions sugar metabolism proceeds by other paths, bypassing the liver; on the other hand, ketonuria decreases and glycaemia increases. Of individual types of sugar, glucose in an 8-10% solution is absorbed best. In severe diabetes with acidosis, enemas of glucose are recommended instead of intravenous infusions. Fats are absorbed in very small quantities, better than others - an emulsion of Provencal oil with soda or a mixture of cream with pancreatin. Norden recommends egg yolk, which gives a good mixture with peptone and dextrin. Alcohol is well absorbed in 3-4% solutions; more concentrated solutions, although absorbed, strongly irritate the mucous membrane. All nutrient enemas must be isotonic (addition of NaCl - 0.85%). - Technique. In prolonged use, addition of T-Opium by 5 drops per enema is recommended. Use of nutrient enemas for more than 10-12 days is not recommended. The most common are small-volume enemas, 150-300 cm³ 2-3 times a day, heated to 33-37°. It is best to use a rubber balloon with a soft tip. It is necessary to carefully monitor the condition of the rectum and the anus (treatment of fissures, washing with boric water, in spasm of the sphincter - suppositories with belladonna or papaverine). Large dropwise enemas of 1000 cm³ of physiol. solution at 38° are also used. 6. Subcutaneous introduction of food is limited mainly to injections of physiol. solution (for small children - Ringer's solution) or 5% solution of glucose in collapse, coma and acute poisoning, but 300-500 cm³ within 5 minutes. Subcutaneous introduction of fat has almost no significance, since fat is not absorbed, but only deposited in the subcutaneous tissue, and emulsified fats cause local necroses. Proteins and their derivatives are almost not applied due to the great danger of anaphylaxis. 7. Intravenous artificial feeding consists in the introduction of glucose in severe surgical operations (before and after anesthesia), for stimulating the liver in the fight against acidosis, in profuse internal bleeding (20-30% solution), intractable vomiting, ischemia of the heart, especially on the basis of angina pectoris (250 cm³, 15% solution), and in diabetics in coma and precomatous state (7-8% solution). American authors recommend frequent introduction of sugar in a 5-7% solution of 500 cm³ 2-3 times a day.

Intravenous administration of physiological solution is applied in collapses, poisonings, and other severe conditions and belongs rather to drug treatment or is reduced to the artificial introduction of large quantities of fluid.