Hi-R-Ed Online

•Hyper/hypoglycemia

•Fluid/electrolyte imbalance

•Refeeding syndrome

•Dumping syndrome

•GI bleeds

Hyperglycemia and hypoglycemia are rare complications of enteral nutrition. Symptoms of hyperglycemia include weakness, nausea, headache, anxiety, frequent urination, and excessive hunger or thirst. This may happen in patients with diabetes, or an injury or illness that changes glucose levels. Diabetes management should be included in enteral nutrition instructions and care plans. In most cases, the rate and volume of enteral nutrition can be maintained.

Hypoglycemia may include shaking, paleness, nausea, sweating, anxiety, heart palpitations, dizziness, weakness, fatigue, headache, and blurred vision. This can happen in cases of diabetes or if a feeding is stopped suddenly for patients on insulin. Immediate action may be to include a source of sugar, such as orange juice without pulp or regular soda pop in the tube. If the patient can swallow, these can be administered orally. The physician should be notified and diabetes management should be included in enteral feeding care planning.

Symptoms of rapid weight loss or gain, thirst, weakness and shakiness, edema, shortness of breath, cramping, numbness and tingling, especially around the mouth or hands, palpitation, taste changes, loss of coordination, and skin changes may signal fluid and electrolyte imbalances. This can result from losses due to diarrhea, vomiting, ostomy output, and an increase or decrease in urine output. These changes should be reported to the physician. Feedings should be stopped if the patient is short of breath or if a fluid overload is suspected. Daily logs of fluid intake, weight, and output of urine and stool can help to find problems early.

Of concern is the introduction of rapid feeding of patients who are depleted due to starvation. In some cases, severely low levels of blood phosphate, potassium, and magnesium can occur along with sodium retention, fluid overload, and thiamine deficiency. In some cases, the rapid changes can lead to life-threatening complications, including respiratory failure, cardiac failure and arrhythmias, rhabdomyloysis (the break down of damaged skeletal muscle tissue which then is released into the bloodstream), seizures, coma, and red and white blood cell dysfunction.

In cases of severe malnutrition, it is recommended to keep the patient under close medical supervision and progress feedings quite slowly. For instance, the goal may be to achieve 20 calories per kilogram of body weight over a period of the first two days, followed by an increase to 25 calories per kilogram body weight by day 3. In addition, therapeutic thiamine and magnesium, phosphate, and potassium can be provided during the first five to seven days. Taking baseline measurements, and then close monitoring of blood values for potassium, phosphate, and magnesium daily, and then for a further two days after the goal rate and volume is achieved, is recommended. After that time, the usual protocol may be used.

Dumping syndrome is the rapid emptying of the gastrointestinal tract that can occur in cases of intestinal tube placement with bolus feeding. Symptoms usually start within 15-30 minutes of feeding and include nausea, vomiting, cramps, diarrhea, and a feeling of fullness. Continuous feeding may be recommended to prevent this problem.

Patients with large surface area burns, major trauma, and some surgical procedures may be at higher risk for developing gastrointestinal bleeding. These patients are also at high risk for malnutrition. Interestingly, enteral feeding has been seen as potentially prophylactic for the development of GI bleeds by providing direct nutrition support to the gut mucosa. It should be noted that severe GI bleeding may be a contraindication for enteral nutrition support.