It is unclear how enteral nutrition via feeding tube should be given when a patient is receiving enteral dilantin. Some caregivers hold the feedings for one hour before and one hour after the dilantin dose to insure adequate absorption of the medication and some caregivers think that the feedings do not need to be interrupted. Both methods are used in this institution. Interrupted feedings has the obvious disadvantage that the patient receives less hours of feeding and requires more nursing intervention. The objective of this study is to determine the change in dilantin levels when enteral feedings are given by the continuous method. Ten patients will be studied. When the dilantin level is in the therapeutic level for two consecutive days on interrupted feedings (baseline), the patient will be switched to continuous feeding uninterrupted for the medication for 7 days. Dilantin levels will be checked daily and if the levels become sub- therapeutic an IV bolus of dilantin will be given and the enteral dose will be increased. Serum albumin will be measured at baseline and at the beginning and end of each week, in order to calculate free dilantin. To date, only one patient has been enrolled in the study and that patient did not complete the study. We plan to continue to enroll in the study until we have ten completed patients.
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