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Appropriate Timing of Enteral Nutrition in Comatose Acute Stroke Patients

Shoko Merrit Yamada

Too early initiation of enteral nutrition (EN) is not advantageous for comatose acute stroke patients. In those patients, the reduction of total protein and albumin was little at day 2 of admission. But the reduction became significant after day 3. Therefore, appropriate nutritional support should be initiated within day 2 after admission in comatose acute stroke patients. When EN started from day 4, recovery of hypoptoteinemia was poor. On the other hand, rapid recovery from hypoptoteinemia was recognized when total parenteral nutrition (TPN) and 20% glucose tube feeding were administered to the patients from Day 4. And incidence of diarrhea was extremely high when EN was initiated from day 4, causing hypoproteinemia, hypovolemia, and unbalance of electrolytes. In acute phase, hypercatabolism occurs in severe stroke patients, and active administration of amino acids and protein may adversely affect nitrogen balance. In hypercatabolism condition, a simple glucose solution is more acceptable than EN. Therefore, for comatose acute stroke patients, TPN and glucose tube feeding should be initiated within 48 hours.