in case of using parenteral nutrition (central or peripheral) is there any contraindication or any recommendation of using proton pump inhibitors( PPI) or H2- blocker in ICU patients??
Dr. Mai many thanks for your interest in nutrition of cancer patients.as it is very important aspect in management. No any contraindication for parenteral nutrition
Proton pump inhibitors (PPI) regulate gastric hypersecretion & prevent peptic ulcer disease, but long-term acid suppression from proton pump inhibitors PPI or H2- blocker increase intestinal PH & may result in small intestinal bacterial overgrowth , may reduce the absorption of important vitamins and nutrients, increased risk of fractures with high-doses by affecting calcium absorption, so the risk benefit ratio should be applied.
This is a topic which came under scrutiny recently. The most recent meta-analysis by Alhazzani suggest that there is no real difference between the two classes of drugs in the General ICU population. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055104
I'm not aware of any specific recommendations for patients on TPN.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055104
http://lifeinthefastlane.com/ccc/stress-ulcer-prophylaxis/
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