Gastrointestinal dysfunction in the critically ill: nutritional implications.

Parenteral therapy is frequently indicated for initial repletion in the severely malnourished patient. Attention should be paid to the nutrients required for initial repletion based on the patient's metabolic needs at the time of therapy, as well as allowance for adequate calories for repletion of body and muscle mass. After the initiation of parenteral therapy and the adequate replacement of fluids and electrolytes, slow introduction of oral or enteric feeding is reasonable. This probably is best handled initially by the use of a nasogastric or nasoenteric feeding tube. However, if the patient willingly ingests oral feedings, the oral route is certainly favorable. Close attention should be paid to the adequacy of gastric emptying. Symptoms of abdominal bloating and diarrhea may require modification of the rate at which oral intake is progressing.