Educational Paper Basics in clinical nutrition: Complications of enteral nutrition Gyorgy Bodoky a , Luiza Kent-Smith b a St. Laszlo Teaching Hospital, Budapest, Hungary b University of Porto, Porto, Portugal article info Article history: Received 8 May 2009 Accepted 13 May 2009 Keywords: Diarrhoea Nausea Vomiting Constipation Aspiration Learning objectives  To know the basic types of complications connected with tube feeding  To be able to prevent complications of enteral nutrition Enteral nutrition (EN), as a form of nutritional therapy, is intended to compensate or overcome the inability of patients to voluntarily ingest food. EN is a relatively safe procedure with limited complications that can usually be avoided or managed. Very often the complications arise from inadequate formula and/or delivery site and rate, as well as being the indirect result of the underlying disease or medical treatment. EN complications can be classified as primarily gastrointestinal, mechanical and metabolic, however, when they occur, the distinction may not be so clear cut, which renders the correct diagnosis of the aetiology a very important issue. 1. Gastrointestinal complications 1.1. Diarrhoea Diarrhoea is perhaps the most common complication in EN, occurring within a wide range (2–63%), depending on how it is defined. Definitions vary from one liquid stool a day to over 500 ml of soft or liquid stools/day on two consecutive days. Diarrhoea is not an inherent complication of EN, it can be prevented if EN is appropriately used i.e. adequate formulation, taking into account the delivery site and patient adjusted rate of infusion. Nevertheless diarrhoea can occur in spite of these safeguards, and it has been shown repeatedly that antibiotics or pathogenic microflora are usually implicated. If clinically significant, the following issues should be addressed: - Review patient’s EN prescription; - Rule out constipation or stool incontinence independent of feeding. Exclude infectious diarrhoea through stool culture; - Review medication profile, searching for diarrhoea inducing drugs, in particular prolonged use of antibiotics; - Should diarrhoea persist, these options ought to be considered:  Decrease delivery rate  Change to EN formula with a source of soluble fibre  If malabsorption is suspected, change to oligomeric or monomeric diets  If, despite the above measures, the problem persists, parenteral nutrition should be considered. 1.2. Nausea and vomiting Approximately 20% of patients on EN experience nausea and vomiting. The last greatly increases the risk of aspiration pneu- monia. Although multifactorial, delayed gastric emptying is the most common cause. Warning signs, in the conscious patient, include abdominal discomfort and/or a sense of bloating. If delayed gastric emptying is suspected, consider reducing sedating medi- cation, switching to a low fat formula, reducing the rate of delivery and administering prokinetic drugs. E-mail address: espenjournals@gmail.com (Editorial Office). Contents lists available at ScienceDirect e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism journal homepage: http://www.elsevier.com/locate/clnu 1751-4991/$ - see front matter Ó 2009 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.eclnm.2009.05.003 e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism 4 (2009) e209–e211