A 16-year-old boy suffers a mid-gut volvulus with massive loss of small intestine. Which of the following statement(s) is/are true concerning his nutritional requirements and management?

a. If at least 18 inches of residual small intestine survives, the patient may tolerate some form of enteral nutrition

b. A nutritional regimen consisting of supplemental glutamine, growth hormone, and a modified high carbohydrate, low fat diet may be beneficial in this patient

c. The regimen described above may decrease the cost of care

Prior to the availability of TPN, most patients developing short bowel syndrome from either surgery or catastrophic event died. In selected patients, however, with residual small intestine (at least 18 inches), post-resectional hyperplasia may develop with time such that they can tolerate enteral feeds. Recent studies have demonstrated the requirement for TPN could be decreased or even eliminated in patients with short-gut syndrome by providing a nutritional regimen consisting of supplemental glutamine, growth hormone, and a modified high carbohydrate, low fat diet. There was a marked improvement in absorption of nutrients with this combination of therapy and a decrease in stool output. In addition, TPN requirements were reduced by 50% as were costs associated with the care of these individuals. Discontinuation of the growth hormone did not increase TPN needs in patients once they had undergone successful gut rehabilitation.