Manual of Clinical Nutrition Management III- 38 Copyright © 2013 Compass Group, Inc.ENTERAL NUTRITION: MANAGEMENT OF COMPLICATIONS (1-7)
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Problem Approaches
Diarrhea Evaluate medication profile (eg, laxatives, stool softeners, antibiotics, medications containing
magnesium, or elixirs containing sorbitol, such as acetaminophen or theophylline).
Check for Clostridium difficile.
Try soluble fiber–containing formula with guar gum (4), or add soluble fiber to the medication
regimen (1) for patients with a low risk for bowl ischemia or bowel dysmotility.
Consider antidiarrheal medications such as loperamide, diphenoxylate, or paregoric if C. difficile or
other infectious complications are ruled out (1).
Use continuous infusion administration. Implement continuous enteral feedings (4).
Try isotonic or peptide-based formula (4).
Observe proper sanitation.
Consider use of prebiotics and probiotics (1).
Nausea,
gastroparesis/
delayed gastric
emptying (1-6)
Evaluate medication profile (eg, opiate analgesics or anticholinergics).
Consider low-fat or isotonic formula.
Reduce the rate of infusion by 20 to 25 mL/hour, or try small bolus feedings of 50 to 100 mL (1,6).
Try motility medications such as a prokinetic agent (eg, metoclopramide or erythromycin) (4).
Administer formula at room temperature (4).
Check and evaluate gastric residual volume prior to each bolus feeding or every 4 hours for
continuous feeding (1,4). If GRV consistently ranges 200 to 500 mL consider promotility agent if
no contraindications (Grade* II) (2).
Check for fecal impaction.
Try antiemetic medications if gastric residual volumes are normal.
Hyperglycemia Monitor blood glucose levels. The target glucose goal is 100 to 150 mg/dL for nondiabetic critically
ill patients (4) and 140 to 180 mg/dL for diabetic critically ill patients (2,7). The target glucose goal
for medically stable patients with diabetes is <140 mg/dL with random blood glucose levels
<180 mg/dL (7). Most critically ill patients with diabetes require intravenous insulin to achieve
the desired glucose range without increasing the risk for hypoglycemia (4,7). More stringent
targets may be appropriate in stable patients with previously tight glycemic control (7). Less
stringent targets may be appropriate in patients with severe comorbidities (7).
Avoid overfeeding. Evaluate total energy compared to estimated requirements (4).
Consult with physician regarding the need for intravenous insulin administration in patients who
experience persistent hyperglycemia (4).
Dehydration Use less concentrated formula.
Supplement with additional water as needed.
Clogged tube Check for proper tube size (viscous formulas should be administered through a >10-French
catheter).
Flush tube with warm water (usually 20 to 30 mL) regularly and before and after administration
of medicines.
Constipation Monitor hydration status.
Add free water.
Consider fiber-containing formula with extra free water (>1 mL free water/kcal) (1).
Consider adding soluble or insoluble fiber medication with extra free water (1).
Increase physical activity if possible.
If hydration is adequate and other causes are ruled out, consider a stool softener (docusate sodium
or docusate calcium), emollients, or laxative (1).
Essential fatty
acid deficiency
Add 5 mL of safflower oil daily^ (1), or provide at least 4% of energy needs as linoleic acid (1).
Change formula to one that contains essential fatty acid.