• Clinical science

Specialized nutrition support

Summary

Specialized nutrition support (SNS) is required when oral intake is either limited or not possible for a prolonged period of time. Common indications for SNS include patients in critical care, those with dysphagia, unconscious patients who cannot be fed, severely malnourished patients, and those with intestinal malabsorption. The two forms of SNS are enteral nutrition and parenteral nutrition. Enteral feeding is always preferred whenever possible, but parenteral feeding may be instituted if the patient has a nonfunctional GI tract (e.g., gastroschisis, short bowel syndromes), and/or if enteral feeding is contraindicated. Patients who are on SNS may develop several complications related to feeding tubes or intravenous catheters, as well as additional metabolic complications such as electrolyte imbalances, hyperglycemia, refeeding syndrome, gallstone disease, and nonalcoholic fatty liver disease.

Indications

Types

  • First-line: enteral feeding
    • Advantages
      • Easier to perform
      • Metabolic complications occur less often
      • Intestinal motility is stimulated, preventing mucosal atrophy
      • Lower risk of blood stream infection
  • Second-line: parenteral feeding

The following principle applies in most situations: oral before enteral, enteral before parenteral!

Enteral feeding

Parenteral nutrition

Metabolic complications

Metabolic complications are more common with parenteral nutrition than enteral nutrition!

last updated 12/10/2019
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