Gastroenteric tube feeding: Techniques, problems and solutions

Table 3 Gastrointestinal complications of enteral nutrition; causes, prevention and treatment

Complication	Cause	Prevention/treatment
Diarrhea	Too rapid increase in amount of feed per day	Observe adaptation phase
	Too rapid infusion rate	Reduce/control infusion rate
	Feed temperature too cold	Increase to room temperature
	Hyperosmolar feedings (> 300 mOsm)	Use isotonic feeding solution, initially
		dilute hyperosmolar feeding solutions
	Lactose intolerance	Use low-lactose or lactose-free diet
	Fat malabsorption	Use low-fat or MCT-containing diet
	Hypoalbuminemia	Use chemically defined diet and/or feed
	Antibiotic therapy or medications	Review medications
	Chemotherapy/radiotherapy	Prescribe antidiarrheal medications
Nausea/vomiting	Too rapid infusion rate	Reduce/control infusion rate
	Bacterial contamination of formula feed/delivery equipment contamination	Handle administration systems hygienically, change delivery equipment every 24 h, keep opened bottles of formula no more than 24 h in refrigerator
Cramps/bloating	Too rapid infusion rate	Reduce/control infusion rate
	Lactose intolerance	Use low-lactose or lactose-free diet
	Fat malabsorption	Use low-fat or MCT-containing diet
Regurgitation/aspiration	Gastric retention	Reduce/control infusion rate, use duodenal tubes, incline patient during food administration
Constipation	Inadequate fluid intake	Increase fluid intake, check fluid balance
	Fiber intake too low	Use fiber-containing formulas
	Fecal impaction	Enemas
	Electrolyte and hormonal derangement	Osmotic laxatives (lactulose 15-60 mL),
		peristaltic agents (e.g., prostigmine 0.25-0.5 mg iv)

MCT: Medium-chain triglyceride.