Diet and nutrition in palliative care

Machine generated contents note: Section I Setting the Scene ch. 1 Need for a Specialized Interest in Food and Nutrition in Palliative Care / Eleni Tsiompanou 1.1.Introduction 1.2.Nutrition is a Science and an Art 1.3.Nutrition as an Important Subject for Patients and their Carers 1.4.Recent Advances in the Science of Nutrition: Genes and the Environment 1.4.1.Nutrigenomics and Epigenetics: How Diet Affects Our `Internal Environment' 1.4.2.Telomeres 1.4.3.The Importance of Micronutrients on Symptom Control 1.4.4.Cancer Survivors 1.5.Multistep Approach to Nutritional Care 1.6.The Diet of People in Illness Should be Different to their Diet in Health 1.6.1.Alteration of Diet in Palliative Care Patients 1.6.2.Food as Medicine 1.6.3.Nutrition as a Safety Issue 1.6.4.Nutritional Care at the End-of-Life 1.7.Development of Specialists: The Need for Nutrition Education 1.8.Conclusion Summary Points Acknowledgments List of Abbreviations References ch. 2 What Do We Mean by Palliative Care? / Catherine Walshe 2.1.Introduction: Why is it Important to Define Palliative Care? 2.1.1.Changing Terms and Their Usage 2.1.2.Value-Laden Interpretations 2.1.3.Defining Palliative Care is Difficult 2.2.Current Definitions of Palliative Care and its Associated Terms 2.3.Key Elements of Definitions 2.3.1.Patient Population 2.3.2.Timing 2.3.3.Holistic Care (Total, Active, and Individualised Patient Care) 2.3.4.Patient, Family and Carers (Support for the Family), and Bereavement Care 2.3.5.Multidisciplinary/Multiprofessional Team Summary Points List of Abbreviations References ch. 3 The World's Major Religions' Views on End-of-Life Issues / Hans-Henrik Billow 3.1.Introduction 3.2.Demographic Challenges 3.3.The Various Religions 3.3.1.Christianity 3.3.1.1.Roman Catholic Perspective 3.3.1.2.Protestantism 3.3.1.3.Greek Orthodox 3.3.2.Judaism 3.3.3.Islam 3.3.4.Hindu and Sikh 3.3.5.Confucian and Taoism 3.3.6.Buddhism 3.4.Guidelines Ethical Issues Summary Points References ch. 4 Why Surgeons Are Ambivalent about Palliative Treatments: A Personal Perspective / Geoffrey P. Dunn 4.1.Introduction 4.2.Background: The Convergent Evolution of the Palliative Model Within and Outside of the Field of Surgery 4.3.What Burn Care Has Taught Surgeons about Palliative Care 4.4.Barriers to the Assimilation of Palliative Principles in Surgical Practice 4.4.1.Cognitive Barriers 4.4.2.Psychologic Barriers 4.4.3.Socioeconomic Barriers 4.4.4.Spiritual Barriers 4.5.Overcoming Surgeons' Ambivalence about Palliative Treatments: The Way Forward 4.6.Summary Key Facts Facts about Surgeons Summary Points List of Abbreviations References ch. 5 Sedation in Palliative Care and Its Impact on Nutrition / Constans A. Verhagen 5.1.Introduction 5.2.What is Palliative Sedation? 5.3.Appropriate Use of Palliative Sedation 5.4.Current Practice in Palliative Sedation 5.5.Guidelines for Palliative Sedation 5.6.Nutritional Patterns of Terminally Ill Patients 5.7.Feeding and Hydration in Terminally Ill Patients 5.7.1.Beneficial Effects of Nutrition and Hydration 5.7.2.Detrimental Effects of Nutrition and Hydration 5.7.3.Ethical Concerns Regarding Nutrition and Hydration 5.8.Nutrition in Sedated Patients 5.8.1.Important Points to Consider 5.8.2.Continuous Sedation 5.8.3.Intermittent Sedation 5.8.4.Light Sedation 5.9.Ethical Considerations of Nutrition 5.10.Applications to Other Areas of Terminal or Palliative Care 5.11.Practical Methods and Techniques Key Points Summary Point References ch. 6 Quality of Life and Aspects of Diet and Nutrition in Dying Children / Finella Craig 6.1.Introduction 6.2.Nutritional Assessment 6.3.Feeding and Nutritional Difficulties in Children with Life-Limiting/Life-Threatening Disease 6.3.1.Mechanical Difficulties: Unsafe Swallow, Gastro-Oesophageal Reflux (GOR) 6.3.2.Gut Dysfunction (Dysmotility and Hypersensitivity) 6.4.Physiological and Other Contributory Factors 6.4.1.Psychological/Social Influences 6.5.End-of-Life Care 6.6.Management 6.7.Tube Feeding 6.7.1.Types of Feeding Tubes 6.7.1.1.Nasogastric Tubes 6.7.1.2.Gastrostomy Tubes 6.7.1.3.Nasojejunal and Jejunostomy Tubes 6.7.1.4.Bolus and Continuous Tube Feeds 6.8.Total Parenteral Nutrition 6.9.Multidisciplinary Teamwork Ethical Issues Summary Points List of Abbreviations References ch. 7 Nutrition and Quality of Life in Adults Receiving Palliative Care / Caroline J. Hollins Martin 7.1.Introduction: The Importance of Nutrition during Palliative Care 7.2.Categories of Nutritional Support 7.3.Issues Regarding Nutritional State, and Palliative Care and Treatment 7.4.Quality of Life 7.5.Definitions of Quality of Life 7.6.Assessment of Quality of Life in People Receiving Palliative Care 7.7.Nutrition, Nutritional Interventions, and QOL 7.8.Application to Other Areas of Health and Disease Definition of Key Points Summary Points List of Abbreviations References ch. 8 Refractory Cancer Cachexia / F. Strasser 8.1.Introduction 8.2.Simple Starvation 8.3.Prevalence and Significance of Cancer Cachexia 8.3.1.Phases 8.3.2.Current Management of Cachexia 8.3.3.Refractory Cachexia 8.3.4.Diagnosing Cachexia 8.3.5.Phases of Cachexia 8.4.Diagnosing Refractory Cachexia 8.4.1.Stores 8.4.2.Intake 8.4.3.Potential 8.4.4.Performance 8.5.Treatment 8.5.1.Palliative Cancer Care 8.5.2.Treatment of Refractory Cachexia 8.5.2.1.Nutritional Interventions 8.5.2.2.Pharmacological Interventions 8.6.Psychosocial Interventions and Emotional Support 8.7.Applications to Other Areas of Terminal or Palliative Care 8.8.Practical Methods and Techniques 8.8.1.Interventions Key Points Ethical Issues Summary Points Acknowledgments List of Abbreviations References Section II Cultural Aspects ch. 9 Nutrition and Hydration in Palliative Care: Japanese Perspectives / Tatsuya Morita 9.1.Introduction 9.2.Concept of a Good Death for Japanese 9.3.Opinions of Patients, Families, and the General Public 9.4.Attitudes of Physicians and Nurses Toward Artificial Hydration 9.5.Essence of the Clinical Guideline 9.5.1.Aims, Target Population, and Quality of Life 9.5.2.Conceptual Framework 9.5.3.Development Process 9.5.4.Specific Recommendations 9.5.4.1.General QOL 9.5.4.2.Ascites 9.5.4.3.Thirst 9.5.4.4.Delirium 9.5.4.5.Bronchial Secretion 9.6.Guidelines Key Facts Regarding Artificial Hydration for Terminally 111 Cancer Patients Ethical Issues Summary Points Note References ch. 10 Nutritional Support in Palliative Care: Chinese Perspectives / Ching-Yu Chen 10.1.Introduction 10.2.Prevalence of Anorexia, Cachexia and Malnutrition in Terminal Cancer Patients 10.3.Current Status of Nutritional Support in Palliative Care 10.4.Applications of Complementary and Alternative Medicine in Palliative Care 10.5.Meaning of Nutritional Support in End-of-Life Care: Practical Guidelines 10.6.Ethical Dilemma Issues of Nutrition and Fluid Support in Terminal Cancer Patients 10.7.Conclusion Summary Points Acknowledgment List of Abbreviations References ch. 11 An Overview of the Indian Perspective on Palliative Care with Particular Reference to Nutrition and Diet / N. Ananthakrishnan 11.1.Introduction 11.2.Relevance of Palliative Care in India 11.3.Difficulty of Palliative Care in India 11.3.1.Resource Deficit 11.3.2.Government Policy 11.3.3.Attitudes of the Medical Fraternity 11.3.4.Lack of Open Communication 11.3.5.Attitudes Towards Hospices 11.4.Factors Conducive to a Good Palliative Care Model in the Country 11.4.1.Family 11.4.2.Support Structures 11.4.3.Cancer Epidemiology 11.4.4.Complementary and Alternate Forms of Medicine 11.5.Overview of Dietary and Nutritional Practices in India 11.6.Nutritional Issues in Palliative Care Ethical Issues Summary Points List of Abbreviations References ch. 12 Cultural Aspects of Forgoing Tube Feeding in American and Hong Kong Chinese Patients at the End-of-Life / Samantha Mei-Che Pang 12.1.Introduction 12.2.A Tale of Two Communities 12.3.To Debate or Not to Debate 12.4.Tube-Feeding Decision in the Cultural Context 12.5.Tube Feeding as an Option or a Solution 12.6.Eating Can Never Be Replaced 12.7.Different Cultures, Same Concern 12.8.Applications to Other Areas of Terminal or Palliative Care 12.9.Features of Tube-Feeding Decisions in Chinese Culture Ethical Issues Summary of Key Points Acknowledgments List of Abbreviations References Section III General Aspects ch. 13 Stents in the Gastrointestinal Tract in Palliative Care / Iruru Maetani 13.1.Introduction 13.2.Esophagus 13.2.1.Malignant Esophageal Stricture 13.2.2.Stent Placement 13.2.3.Practical Methods and Techniques 13.2.4.Efficacy and Complications 13.2.5.Cervical Esophagus and GE Junction 13.3.Stomach and Duodenum 13.3.1.Gastric Outlet Obstruction 13.3.2.Stent Placement 13.3.3.Practical Methods and Techniques 13.3.4.Efficacy and Complications 13.3.5.Stent Placement versus Gastrojejunostomy 13.4.Colorectum 13.4.1.Colorectal Obstruction 13.4.2.Stent Placement 13.4.3.Practical Methods and Techniques 13.4.4.Efficacy and Complications 13.4.5.Stent Placement versus Surgical Alternatives 13.5.Application of Stenting to Other Areas of Palliative Care Ethical Issues Summary Points List of Abbreviations References ch. 14 Artificial Nutrition, Advance Directives, and End-of-Life in Nursing Homes / Cheryl Ann Monturo 14.1.Introduction

Note continued: 14.2.Nursing Homes 14.2.1.Personnel to Meet the Demands 14.2.2.Palliative Care Services 14.2.3.Palliative Care Education 14.2.4.Regulations 14.2.5.Cognitive Impairment 14.3.Advance Directives 14.3.1.Historical Evolution 14.3.2.Usefulness of Advance Directives 14.4.Artificial Nutrition 14.4.1.Enteral Nutrition History 14.4.2.Enteral Nutrition Use 14.5.Practical Guidelines for Alternatives to Artificial Nutrition Key Features of Nursing Homes Ethical Issues Summary Points Acknowledgments List of Abbreviations References ch. 15 Support for Hydration at End-of-Life / Robin L. Fainsinger 15.1.Introduction 15.2.Background to the Hydration Controversy 15.3.Clarifying Terminology 15.4.Hydration Research 15.5.Social, Cultural, and Ethical Issues 15.6.Options for Alternative Hydration 15.6.1.Nasogastric Tubes and Gastrostomy 15.6.2.Hypodermoclysis 15.6.3.Rectal Hydration Key Points Summary Points References ch. 16 Palliative Treatment of Dysphagia / Christian Selinger 16.1.Introduction 16.2.Pathophysiology and Anatomy of Dysphagia 16.2.1.Neuromuscular Dysphagia 16.2.2.Dysphagia by Oral, Head and Neck Cancers 16.2.2.1.Oesophageal and High Gastric Obstruction 16.2.2.2.Gastric Outlet Obstruction 16.3.Applications to Other Areas of Terminal or Palliative Care 16.4.Practical Procedures and Techniques 16.4.1.Nasogastric Tube (NG) Insertion 16.4.2.Endoscopically Placed Feeding Tubes 16.4.3.Radiologically Induced Gastrostomy 16.4.4.Stents 16.4.5.Surgically Placed Feeding Tubes 16.4.6.Surgical Bypass Procedures 16.5.Evidence for Dysphagia Treatment According to Indication 16.5.1.Neurological and Muscular Disorders 16.5.1.1.Stroke Disease 16.5.1.2.Motor-Neuron Disease 16.5.1.3.Dementia 16.5.2.Other Neuromuscular Diseases 16.6.Head and Neck Tumours 16.6.1.Oesophageal and High Gastric Obstruction 16.6.2.Gastric Outlet Obstruction Ethical Issues Summary Points List of Abbreviations References ch. 17 Fatigue in Hospice Cancer Patients: How Do Nutritional Factors Contribute? / Shiow-Ching Shun 17.1.Introduction 17.2.Definition of Cancer-Related Fatigue (CRF) 17.3.Pathophysiology of Fatigue 17.4.Malnutrition and Cancer-Related Fatigue in Terminal Patients 17.4.1.Malnutrition, Cachexia, and Fatigue 17.4.2.Malnutrition Related to Anorexia, Treatments, and Cancer 17.5.Cancer-Related Symptoms Directly Influencing Food Intake and Fatigue 17.5.1.Head and Neck Cancer-Related Problems 17.5.2.Gastrointestinal System-Related Problems and Malnutrition 17.6.Common Physical Symptoms Related to Food Intake and Fatigue 17.7.Psychological Distress, Fatigue, and Malnutrition 17.8.Managing Cancer-Related Fatigue in Terminal Cancer Patients: Integrating Nutrition-Related Factors Ethical Issues Summary Points List of Abbreviation References ch. 18 Taste Alteration in Palliative Care / Michio Sata 18.1.Introduction 18.2.Types of Taste Alterations 18.2.1.Assessments of Taste Alteration 18.2.2.Mechanisms of Taste Alteration 18.3.Practical Methods and Techniques 18.3.1.Modification of Food 18.3.1.1.Flavors 18.3.1.2.Palatability 18.3.2.Agents 18.3.2.1.Sialogogues 18.3.2.2.Saliva substitutes 18.3.3.Nutrients 18.3.3.1.Zinc 18.3.3.2.BCAA 18.4.Conclusion Summary Points Acknowledgments List of Abbreviation References ch. 19 Olfaction in Palliative Care Patients / Yoav P. Talmi 19.1.Introduction 19.2.Biology of Olfaction 19.3.Causes of Impaired Olfaction 19.4.Practical Methods and Techniques Summary Points References ch. 20 Withholding or Withdrawing Nutritional Support at the End-of-Life in Six European Countries / Agnes van der Heide 20.1.Introduction 20.2.Nation-Wide Death Certificate Studies 20.2.1.Frequencies of Withholding or Withdrawing ANH in Six West European Countries 20.2.2.Characteristics of Patients in Whom ANH was Forgone in Six West European Countries 20.3.Communication About Withholding or Withdrawing ANH 20.4.Withholding or Withdrawing ANH in Combination with Possibly Life-Shortening Drugs to Relieve Symptoms 20.5.International Differences 20.6.Applications to Other Areas of Terminal or Palliative Care 20.7.Guidelines Key Facts in How to Distinguish Forgoing Artificial Nutrition or Hydration from Other Medical End-of-Life Decisions Ethical Issues Summary Points Acknowledgments List of Abbreviations References Section IV Cancer ch. 21 The Concept of Cachexia-Related Suffering (CRS) in Palliative Cancer Care / F. Strasser 21.1.Introduction 21.2.Malnutrition 21.3.Cachexia-Related Suffering (CRS) 21.3.1.Prevalence of CRS 21.3.2.Characteristics of CRS 21.3.2.1.Presentation of CRS 21.3.2.2.Mechanisms Leading to CRS 21.3.3.Reactions to CRS 21.3.3.1.Constructive Reactions 21.3.3.2.Adverse Reactions 21.3.4.Assessment of CRS 21.4.Applications to Other Areas of Terminal or Palliative Care 21.5.Practical Methods and Techniques Key Points Ethical Issues Summary Points Acknowledgments List of Abbreviations References ch. 22 An Overview of Gastrointestinal Side Effects in Tumour Therapy: Implications for Nutrition / Frank Mayer 22.1.Introduction 22.2.Nausea and Vomiting 22.2.1.Pharmacological Therapy of Nausea and Vomiting 22.2.2.Nutritional Impact of Nausea and Vomiting 22.2.2.1.General Aspects 22.2.2.2.Ginger to Prevent or Reduce Emesis 22.3.Mucositis 22.3.1.Prevention and Therapy of Mucositis 22.3.2.Nutritional Impact of Mucositis 22.4.Diarrhoea 22.4.1.Assessment and Early Intervention 22.4.2.Nutritional Impact of Diarrhoea 22.4.2.1.Glutamine for Protection of the Intestinal Mucosa 22.4.2.2.Probiotics for Prevention of Diarrhoea 22.5.Constipation 22.5.1.Pharmacological Therapy of Constipation 22.5.2.Managing Constipation 22.5.3.Nutritional Impact of Constipation 22.6.Changes in Perception of Taste and Smell Key Facts of Malnutrition Ethical Issues Summary Points List of Abbreviations References ch. 23 Nutritional Status and Relationship to Upper Gastrointestinal Symptoms in Patients with Advanced Cancer Receiving Palliative Care / Tiziana Sappia 23.1.Introduction 23.1.1.Malnutrition: Causes and Consequences 23.2.Application to Other Areas of Palliative Care 23.3.Practical Procedures and Techniques 23.3.1.Case History 23.3.2.Dietary Records 23.3.3.Physical Examination 23.3.4.Anthropometric Assessment 23.3.4.1.Body Weight 23.3.4.2.Body Height 23.3.4.3.Circumferences 23.3.5.Laboratory Analysis 23.3.5.1.Plasma Proteins 23.3.5.2.Laboratory Analysis to Assess Muscle Mass 23.3.5.3.Nitrogen Balance 23.3.5.4.Immunological Tests 23.3.5.5.Functional Tests 23.3.6.Nutritional Screening Tools 23.3.7.Human Body Composition 23.3.7.1.Body Composition Measurement Techniques 23.4.Aspects of Nutritional Status in Palliative Care 23.5.Relationship between Nutritional Status and Upper Gastrointestinal Symptoms Ethical Issues Summary Points List of Abbreviations References ch. 24 Nutrition and Palliative Surgery for Head and Neck Cancer / Ryuichi Hayashi 24.1.Introduction 24.1.1.Advanced Head and Neck Cancer 24.1.2.Nutrition and Quality of Life 24.2.Applications in Other Areas of Terminal or Palliative Care 24.3.Practical Methods and Techniques 24.3.1.Palliative Surgery 24.3.2.Complications and Hospitalization 24.3.3.Case 1 24.3.4.Case 2 24.3.5.Indication Key Facts of Head and Neck Cancer Ethical Issues Summary Points List of Abbreviations References ch. 25 Total Parenteral Nutrition for Patients with Advanced, Life-Limiting Cancer: Clinical Context, Potential Risks and Benefits, and a Suggested Approach / Jane L. Wheeler 25.1.Introduction 25.2.Metabolic Changes in the Patient with Advanced Cancer 25.3.Cancer Anorexia-Cachexia Syndrome 25.4.Total Parenteral Nutrition 25.5.Clinical Risks Associated with TPN 25.6.Potential Negative Effects of TPN 25.7.Potential Positive Effects of TPN 25.8.Applications to Other Areas of Terminal or Palliative Care 25.9.Guidelines for Clinical Practice 25.9.1.Guidelines for Patients with Advanced Cancer 25.9.2.Additional Factors Influencing the Palliative Use of TPN 25.9.3.TPN: A Pragmatic Clinical Approach Key Points to Communicate to Patients and Their Families Ethical Issues Summary Points List of Abbreviations References ch. 26 Vitamin Deficiency in Patients with Terminal Cancer / Dominic J. Harrington 26.1.Introduction 26.1.1.Challenges Faced by Patients with Terminal Cancer 26.2.Fat-Soluble Vitamins 26.2.1.Vitamin A 26.2.2.Vitamin D 26.2.3.Vitamin E 26.2.4.Vitamin K 26.3.Water-Soluble Vitamins 26.3.1.Vitamin C (Ascorbic Acid) 26.3.2.Folate (Vitamin B9) 26.3.3.Vitamin B12 26.3.4.Vitamin B6 26.3.5.Thiamine (Vitamin B1) 26.3.6.Riboflavin (Vitamin B2) 26.3.7.Niacin (Vitamin B3) 26.3.8.Biotin (Vitamin B7) 26.3.9.Pantothenic Acid (Vitamin B5) 26.4.Practical Methods and Techniques 26.4.1.Fat-Soluble Vitamins 26.4.1.1.Vitamin A 26.4.1.2.Vitamin D 26.4.1.3.Vitamin E 26.4.1.4.Vitamin K 26.4.2.Water-Soluble Vitamins 26.4.2.1.Vitamin C 26.4.2.2.Folate 26.4.2.3.Vitamin B12 26.4.2.4.Vitamin B6 26.4.2.5.Thiamine (Vitamin B1) 26.4.2.6.Riboflavin (Vitamin B2) 26.4.2.7.Niacin (Vitamin B3) 26.4.2.8.Biotin (Vitamin B7) 26.4.2.9.Pantothenic Acid (Vitamin B5) Key Facts: Vitamin Deficiency in Patients with Terminal Cancer Summary Points Acknowledgments List of Abbreviations References

Note continued: ch. 27 Position of Appetite and Nausea in Symptom Clusters in Palliative Radiation Therapy / Edward Chow

27.1.Introduction

27.2.Key Features of Symptom Clusters

27.2.1.What Are They?

27.2.2.Why Are They Useful?

27.3.Tools Used in Symptom Cluster Research

27.4.Radiation-Induced Nausea/Vomiting

27.5.Nausea/Vomiting and Appetite in Symptom Clusters in Bone Metastases

27.6.Nausea/Vomiting and Appetite in Symptom Clusters in Brain Metastases

27.6.1.Studies Conducted

27.6.2.Study Conclusions

27.7.Applications to Other Areas of Palliative Care

27.8.Guidelines

Ethical Issues

Summary Points

List of Abbreviations

References

ch. 28 Palliative Gastrojejunostomy and the Impact on Nutrition in Cancer / Jeffrey M. Farma

28.1.Introduction

28.1.1.Acute Presentation of GOO

28.1.2.Clinical Presentation

28.1.3.Diagnostic Evaluation

28.2.Nutritional Complications of GOO

28.2.1.Proximal GOO

28.2.2.Duodenal and Biliary Obstruction

28.2.3.Pancreatic Duct Obstruction

28.2.4.Nutritional Deficiencies

28.3.Surgical Techniques

28.3.1.Gastrojejunostomy

28.3.2.Risks Associated with Gastrojejunostomy

28.3.3.Partial Stomach-Partitioning Gastrojejunostomy

28.3.4.Role of Prophylactic Gastrojejunostomy

28.4.Biliary Obstruction

28.5.Minimally Invasive Surgical Techniques

28.6.Non-Surgical Options

28.7.Guidelines

Ethical Issues

Summary Points

List of Abbreviations

References

Section V Other Conditions

ch. 29 Nutritional Support in the Vegetative State: Artificial Nutrition and Hydration in the Limbo between Life and Death / Giuseppe Nattino

29.1.Introduction

29.1.1.The Vegetative State

29.1.2.Nutrition in PVS Patients

29.2.Applications to Other Areas of Terminal or Palliative Care

29.3.Practical Methods and Techniques

29.3.1.Energy Expenditure

29.3.2.Nutritional Requirements in PVS Patients

29.3.3.Enteral Feeding Routes and Techniques

29.3.4.Complications and Their Prevention

29.3.4.1.Constipation, Impaired Gastrointestinal Motility, and Diarrhea

29.3.4.2.Tube Occlusion

29.3.4.3.Accidental Tube Removal

29.3.4.4.Gastric Sores Due to the Internal Portion of the Tube

29.3.4.5.Intestinal Occlusion by Tube Dragging

29.4.Ethical Issues

29.4.1.Artificial Nutrition and Hydration (ANH): Medical Treatment or Loving Care?

29.4.2.Withdrawing ANH

29.4.3.Ethical Principles Informing the Decision

Summary Points

List of Abbreviations

References

ch. 30 Nutrition and Appetite Regulation in Children and Adolescents with End-Stage Renal Failure / Jorg Dotsch

30.1.Introduction

30.2.Appetite Regulation

30.2.1.Normal Appetite Regulation

30.2.2.Dysregulation of Appetite in End-Stage Renal Disease

30.2.2.1.Leptin and Ghrelin

30.2.2.2.Uremia

30.3.Protein Energy Wasting

30.3.1.Inflammation

30.3.2.Dialysate Nutrient Losses

30.3.3.Metabolic Acidosis

30.3.4.Endocrine Disorders and Concomitant Diseases

30.4.Nutrition and Diet

30.4.1.General Aspects of Nutrition and Diet in End-Stage Renal Failure

30.4.1.1.Calories, Protein, and Body Weight

30.4.1.2.Sodium and Fluids

30.4.1.3.Phosphorus and Calcium

30.4.1.4.Potassium

30.4.1.5.Vitamins and Minerals

30.4.2.Infants

30.4.3.Children

30.4.4.Adolescents

30.4.5.Adults

30.5.Application to Other Areas of Terminal or Palliative Care

30.6.Practical Methods and Techniques

Key Facts of Renal Failure

Ethical Issues

Summary Points

List of Abbreviations

References

ch. 31 Nutrition in End-Stage Liver Disease / Valentina Medici

31.1.Introduction

31.2.Pathophysiology of Malnutrition in End-Stage Liver Disease

31.3.Specific Nutrient Deficiencies in End-Stage Liver Disease and Associated Clinical Features

31.3.1.Protein Calorie Malnutrition

31.3.2.Vitamins

31.3.3.Minerals

31.4.Evaluation of Nutritional Status in End-Stage Liver Disease

31.5.Treatment

31.6.Applications to Other Areas of Terminal or Palliative Care

31.7.Practical Methods and Techniques

Key Points of Malnutrition in End-Stage Liver Disease

Ethical Issues

Summary Points

List of Abbreviation

References

ch. 32 Nutritional Therapy in Amyotrophic Lateral Sclerosis / Susanne Petri

32.1.Introduction

32.2.Nutrition Principles in ALS

32.3.Management of Dysphagia

32.4.Enteral Nutrition in ALS

32.4.1.Nasogastric Tube in ALS

32.4.2.Percutaneous Endoscopic Gastrostomy in ALS

32.4.2.1.Timing of PEG Tube Placement

32.4.2.2.PEG and Aspiration

32.4.3.Percutaneous Radiologic Gastrostomy/Radiologically Inserted Gastrostomy

32.5.Home Parenteral Nutrition in ALS

Ethical Issues

Summary Points

List of Abbreviations

References

ch. 33 Nutritional Considerations of Palliative Care in Rare Disease: The Motor Disorder Disease Achalasia / Fabio Cisaro

33.1.Introduction

33.2.Pathophysiology

33.3.Clinical Picture and Diagnosis

33.4.Treatment Options

33.4.1.Pharmacologic Treatments

33.4.2.Endoscopic Procedures

33.4.3.Surgical Treatment

33.5.Applications to Other Areas of Palliative Care

33.6.Guidelines and Practical Methods and Techniques

33.7.Nutritional Aspects of Achalasia

Ethical Issues

Summary Points

List of Abbreviations

References

Section VI Pharmacological Aspects

ch. 34 Steroid-Induced Side Effects Affecting Diet and Nutrition in Palliative Care: Oral Candidiasis and Other Conditions / Jana Pilkey

34.1.Introduction

34.2.Oral and Esophageal Candidiasis

34.3.Risk Factors

34.4.Practical Methods and Techniques

34.4.1.Diagnosis

34.4.2.Treatment

34.4.3.Ethical Issues

34.5.Gastritis and Gastroduodenal Ulceration

34.5.1.Incidence

34.5.2.Risk Factors

34.6.Practical Methods and Techniques

34.6.1.Prophylaxis and Treatment

34.6.2.Ethical Issues

34.7.Impaired Glucose Metabolism

34.7.1.Monitoring

34.7.2.Practical Methods and Techniques

34.7.2.1.Oral Agents

34.7.2.2.Insulin

34.7.3.Ethics and Diabetic Management in the Dying

34.7.4.Hiccups

34.8.Applications to Other Areas of Palliative Care

Summary Points

Acknowledgments

List of Abbreviations

References

ch. 35 Appetite Stimulant Use in the Palliative Care of Cystic Fibrosis / Darcie D. Streetman

35.1.Introduction

35.2.Appetite Stimulants

35.2.1.Megestrol Acetate (MA)

35.2.2.Cyproheptadine Hydrochloride (CH)

35.2.3.Dronobinal (Marinol�)

35.2.4.Antipsychotic/Antidepressant Agents

35.2.4.1.Antipsychotic Drugs

35.2.4.2.Antidepressants

35.2.5.Recombinant Human Growth Hormone (rhGH)

35.2.6.Anabolic Androgenic Steroids (AAS)

35.3.Applications to Other Areas of Terminal or Palliative Care

Ethical Issues

Summary Points

List of Abbreviations

References

ch. 36 Warfarin

Nutrition Interactions in the Hospice and Palliative Care Setting / Jeffrey L. Spiess

36.1.Introduction

36.2.The Coagulation Cascade

36.3.Vitamin K Antagonists

36.4.Warfarin in Clinical Practice

36.5.Warfarin Indications and Cautions

36.6.Vitamin K

36.7.Vitamin K as a Therapeutic Agent

36.8.Non-Vitamin K Warfarin-Nutrition Interactions

36.9.Application to Other Areas of Terminal or Palliative Care

36.10.Guidelines

Ethical Issues

Summary Points

Acknowledgments

List of Abbreviations

References.