29-30: Complications of Enteral Nutritional Support

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 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 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.