Minor complications of enteral nutritional support occur in 10–15% of patients. Gastrointestinal complications include diarrhea (most common), inadequate gastric emptying, emesis, esophagitis, and occasionally gastrointestinal bleeding. Diarrhea associated with enteral nutritional support may be due to intolerance to the osmotic load or to one of the macronutrients (eg, fat, lactose) in the solution. Patients being fed in this way may also have diarrhea from other causes (as side effects of antibiotics or other drugs, associated with infection, etc), and these possibilities should always be investigated in appropriate circumstances.
Mechanical complications of enteral nutritional support are potentially the most serious. Of particular importance is aspiration. All patients receiving nasogastric tube feedings are at risk for this life-threatening complication. Limiting nasogastric feedings to those patients who can adequately protect their airway and careful monitoring of patients being fed by tube should limit these serious complications to 1–2% of cases. Minor mechanical complications are common and include tube obstruction and dislodgment.
Metabolic complications during enteral nutritional support are common but are easily managed in most cases. The most important problem is hypernatremic dehydration, most commonly seen in elderly patients given excessive protein intake who are unable to respond to thirst. Abnormalities of potassium, glucose, CO2 production, and acid–base balance may also occur.
et al. Nutrition support in hospitalised adults at nutritional risk. Cochrane Database Syst Rev. 2017 May 19;5:CD011598.
et al. Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Jun 8;6:CD012276.
et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018 Jan 13;391(10116):133–43.
et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017 Mar;43(3):380–98.
et al. Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: a systematic review and meta-analysis. Medicine (Baltimore). 2018 Oct;97(41):e11874.
et al. Enteral versus parenteral nutrition in critically ill patients with severe pancreatitis: a meta-analysis. Eur J Clin Nutr. 2018 Jan;72(1):66–8.
et al. The effect of enteral versus parenteral nutrition for critically ill patients: a systematic review and meta-analysis. J Clin Anesth. 2018 Dec;51:62–92.