From the Guidelines
Normal free water intake before feeding is typically up to 1500-2000 mL daily, and after feeding is established, it may increase to 2000-3000 mL daily, depending on the patient's clinical status and fluid needs, as suggested by the European Food Safety Authority (EFSA) guidelines 1. When considering fluid intake, it's essential to take into account individual factors such as energy consumption, water losses, and kidney function. The EFSA recommends an Adequate Intake (AI) of 2.0 L/day for women and 2.5 L/day for men of all ages, with 70-80% of fluid coming from drinks 1. Feeding should be held when patients show signs of feeding intolerance, such as:
- High gastric residual volumes (typically >250-500 mL)
- Vomiting
- Abdominal distension
- Severe diarrhea Additionally, feeding should be held before procedures requiring sedation (usually 6-8 hours prior), when hemodynamic instability occurs, or if the patient develops severe electrolyte abnormalities. It's also crucial to consider the risk of refeeding syndrome when commencing feeds in patients who have recently starved, and to provide generous electrolyte supplements and thiamine to prevent complications 1. In terms of postoperative care, a multifaceted approach to minimizing postoperative ileus, including optimized fluid management, opioid-sparing analgesia, and early mobilization, can help reduce the risk of complications 1.
From the Research
Normal Free Water Levels
- Normal free water levels before and after feeding are not explicitly stated in the provided study 2
- However, the study highlights the importance of considering "hidden" sources of fluid intake and output in water balance calculations
Holding Feeding
- The study does not provide specific guidelines on when to hold feeding 2
- It emphasizes the need to evaluate risk factors, subjective, objective, and laboratory parameters to assess dehydration in long-term tube-fed patients
- Factors such as altered mental status, inability to communicate, elderly status, fluid restriction, and thirst impairment are identified as risks for dehydration, but no direct link to holding feeding is made 2
Dehydration Evaluation and Treatment
- The study discusses the evaluation, treatment, and prevention of dehydration in long-term tube-fed patients 2
- It suggests that the method for treatment and prevention of dehydration depends on the presence or absence of hypovolemia, type of body fluid losses, and whether the patient demonstrates hypernatremia, normonatremia, or hyponatremia 2