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Parenteral nutrition is given inappropriately in almost a third of adult cases, report says

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c3267 (Published 24 June 2010) Cite this as: BMJ 2010;340:c3267

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Parenteral nutrition: the easy way out in developing countries

Tuli L, Singh DK.
E mails: tuli_lekha@rediffmail.com, deepakbhu@gmail.com.

The article [1, 2] reveals a very important drawback associated with
the misuse of parenteral nutrition. This is report from a developed nation
laying stress on overuse of parenteral nutrition but the problem could be
much worse in the developing countries.

In a developing nation stringent control on the medical practices is
very difficult. The presence of quacks worsens the scenario in these
regions. These quacks use parenteral nutrition as a tool to mislead the
patients. It is a very easy way of earning money, fake demonstration of a
treatment, increasing clientele (patients) and easy way out to fill the
knowledge gap by using a modality with no severe and unavoidable
consequences if properly monitored.

On the other hand, physicians also use parenteral nutrition as a
precautionary method with the idea that it is harmless.’ Even if it does
not benefit or improve the patient’s condition it won’t worsen it also!’
Also, the availability of the laboratory in the immediate vicinity
empowers the doctors to exercise control over parenteral nutrition with
ease.

Another reason is that the parenteral nutrition can be easily
quantified and monitored as compared to the oral feeding. This is an added
advantage when treating illiterate patients who are difficult to instruct.
So, it fills the communication and treatment gap in these cases.

Parenteral nutrition provides a psychological support to the patients
that they are being treated properly. It helps in alleviating apprehension
and anxiety with an assurance that they are cared for and their visit to
the hospital is not a waste, which also adds to the advantage of this
treatment. At times patient undergoing investigations are kept on
intravenous fluids until any definitive decision on the course of
treatment. Or else, they keep questioning their stay in the hospitals.
Though, the use of placebo or health awareness could help replace such
fruitless intervention.

Patient illiteracy which is rife in a developing country modifies and
liberates the use too. Patient illiteracy is a boon for the physicians as
they are blindly trusted and never questioned about the treatment until
any severe health hazard ensues. Defensive medicine also is not required
due to health unawareness. As a result the less experienced doctors and
the quacks exercise more freedom to use this modality with minimal regard
to patient’s health or requirement.

Problems could be further accentuated due to lack of addition of
micronutrients in the bags as per the National Institute for Health and
Clinical Excellence guidelines [1]. A similar study [2] may bring to light
these shortcomings prevalent in the developing countries.

References:

1. Gulland A. Parenteral nutrition is given inappropriately in almost
a third of adult cases, report says. BMJ 2010; 340:c3267.

2. A mixed bag: an enquiry into the care of hospital patients receiving
parenteral nutrition is at www.ncepod.org.uk.

Competing interests:
None declared

Competing interests: No competing interests

29 June 2010
Lekha Tuli
Researcher
Deepak K. Singh
Institute of Medical Sciences,BHU,Varanasi,India