Ramesh met an accident with a car and has been in `deep coma’ for the last 15 days. The most suitable route for the administration of protein and calories is by :
**Core Concept**
The question is testing the knowledge of nutritional support in critically ill patients, specifically those in a coma. Enteral nutrition is the preferred route for providing protein and calories in such patients, as it maintains gut integrity and reduces the risk of complications.
**Why the Correct Answer is Right**
In patients with a deep coma, the goal is to provide adequate nutrition to support recovery and prevent malnutrition. Enteral nutrition is preferred over parenteral nutrition as it allows for the delivery of nutrients directly into the gastrointestinal tract, which helps maintain gut function and reduces the risk of complications such as bacterial translocation and liver dysfunction. The jejunostomy is a suitable route for enteral nutrition in patients who are unable to take food orally, as it allows for direct access to the jejunum, which is more distal to the stomach and has a thicker mucosa, making it less susceptible to irritation from the formula.
**Why Each Wrong Option is Incorrect**
**Option A:** Parenteral nutrition is not the preferred route in this scenario, as it can lead to complications such as liver dysfunction and bacterial translocation.
**Option B:** Nasogastric tube is not suitable for long-term nutrition support in patients with a deep coma, as it can cause irritation and discomfort, and may lead to aspiration.
**Option C:** Gastrostomy is not the most suitable option in this scenario, as it may not provide adequate access to the jejunum, and may lead to complications such as leakage and infection.
**Clinical Pearl / High-Yield Fact**
In critically ill patients, early enteral nutrition within 24-48 hours of admission is associated with improved outcomes, including reduced morbidity and mortality.
**Correct Answer: C. Jejunostomy.