GI Complications

Ā© GI complications are the most common complications of EN limiting the amount of feeding that patients receive. Although diarrhea frequently is blamed on the tube feeding formula or the method of EN administration, other possible causes of diarrhea usually exist (see Table 101-8). Many of these are related to the fact that, particularly in the inpatient setting, patients receiving EN frequently are some of the sickest patients in the hospital. Along these lines, Clostridium difficile colitis must be considered as a possible cause of diarrhea, especially in patients who have been receiving antimicrobial therapy or proton pump inhibitors.3 -36 Antibiotic therapy is a major cause of diarrhea in acutely ill patients, including those receiving EN. A medication-related cause of diarrhea largely overlooked until the early 1990s is the sorbitol content of

medications. Large quantities of this substance present in many oral liquid medications (often considered the dosage form of choice for administration through a feeding tube) can cause diarrhea. Unfortunately, the sorbitol content of many medications is not listed on their labeling, and some manufacturers state that they frequently reformulate these preparations to contain varying amounts of excipients, such as sorbitol. Determining the cause of the diarrhea is obviously important to know how to address the problem. Whereas C. difficile colitis should be treated with metronidazole or van-comycin, sorbitol-or other medication-induced diarrhea can be addressed by removal of the offending agent. Likewise, diarrhea secondary to malabsorption sometimes can be addressed by changing to an oligomeric EN formula. Antiperistaltic agents such as loperamide may be useful in some cases of diarrhea of noninfectious etiology.

On the other hand, constipation may occur in some patients receiving tube feedings, especially the elderly. Increased provision of fluid or fiber may be useful in attaining bowel regularity. As with diarrhea, constipation may be drug-related, in which case discontinuation or replacement of the offending drug may help alleviate the problem.

Table 101-8 Complications of Tube Feeding

Complication Causes

Diarrhea Drug related

Antibiotic-induced bacterial overgrowth Hyperosmolar medications administered via feeding tubes Antacids containing magnesium Malabsorption Hypoalbuminemia/gut mucosal atrophy Pancreatic insufficiency Inadequate GIT surface area Rapid GIT transit Radiation enteritis Tube feeding related Rapid formula administration Formula hyperosmolality Low residue (fiber) content Lactose intolerance Bacterial contamination Nausea and vomiting Gastric dysmotility (surgery, anticholinergic drugs, diabetic gastroparesis) Rapid infusion of hyperosmolar formula

Constipation Dehydration

Drug induced (anticholinergics) Inactivity

Low residue (fiber) content Obstruction/fecal impaction Abdominal distention/ Too rapid formula administration cramping


Occluded feeding tube lumen

Tube displacement Aspiration

Peristomal excoriation Infectious

Aspiration pneumonia

Insoluble completion of enteral formula and medicationĀ® Inadequate Hushing of feeding tube Undissolved feeding formula Self-extu bation Vomiting or coughing inadequate fixation (jejun ostomy) improper patient position Castro pa res is/atomy causing regurgitation Feeding tube maipositioned Co m p ro m i sed I ower esop hagea I

sphincter Diminished gag reflex improper skin and tube care GIT see rel ions feaking peristoma I ly

Sam e as tech n ica I a s p i ration comments Prolonged use of large bore polyvinylchloride tube

From Janson DD, Chessman KH. Enteral nutrition. In DiPiro JT", Talbert Rlr Yee GC et al, eds. Pharmacotherapy; A Pathophysiologic Approach, Sth ed. New York; McGraw-Hill, 200b.

Table 101-9 Suggested Monitoring for EN Patients to Prevent the Development of Complications


During Initiation of EN Therapy

During Stable EN Therapy

Vital signs

Every 4-6 hours

Clinical assessment

Weight Daily

Length/height (children) Weekly-monthly Head circumference Weekly-morthly (less than 3 years of age)

Total intake/output Daily

Tube feeding intake Daily Enterostomy tube site Daily assessment

As needed with suspected change (i.e., fever)




As needed with suspected changed in intake/output Daily Daily

Gl tolerance

Stool frequency/volume Ffciily Abdomen assessment Dally Nausea o r vom iti ng Da i ly Gastric residual volumes tvery 4-S hours


Tube placement

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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