Enteral nutrition is the preferred feeding method in patients with functional GI tracts, however complications occur in 10–15%. Minor mechanical complications are common and include tube occlusion and dislodgment. Common GI complications include diarrhea, nausea, vomiting, and constipation. GI bleeding from feeding tube placement may occur but is less common. Diarrhea is the most common complication. Diarrhea may be caused by the formula itself (ie, intolerance to a hyperosmotic load or to a specific component in the formula), medications, infections, or related to a primary disease of the intestine. All possibilities should be considered before attributing diarrhea to the enteral nutrition.
One of the most serious complications of enteral nutritional support is the risk of aspiration. Aspiration is best prevented by identifying patients who are at risk and utilizing protocols to reduce risk that include elevating the head of bed to 30 degrees, checking gastric residual volumes every 4 hours, utilizing promotility agents, and placing post-pyloric feeding tubes, as appropriate.
Metabolic complications during enteral nutritional support are less likely to be caused by the enteral nutrition itself and more likely related to underlying conditions that predispose patients to metabolic alterations. The most common complications include refeeding syndrome, electrolyte derangements, hyperglycemia, and dehydration.
MM. Nutrition and micronutrient therapy in critical illness should be individualized. JPEN J Parenter Enteral Nutr. 2020;44:1380.