What are the most common complications of enteral (tube feeding directly into the gastrointestinal tract) and parenteral (intravenous feeding) nutrition?

Most Common Complications of Enteral and Parenteral Nutrition

The most common complication of parenteral nutrition is catheter-related bloodstream infection (sepsis), while intestinal villous atrophy is a significant complication associated with lack of enteral nutrition. 1

Parenteral Nutrition Complications

Infectious Complications

• Catheter-related bloodstream infections (CLABSIs): These are the most common and serious complications associated with parenteral nutrition 1
  • Incidence ranges from 3.8 to 11.3 infections per 1000 catheter days 1
  • Major pathogens include Gram-positive coagulase-negative staphylococci (30-40%), Gram-positive staphylococci (7.7-15%), Gram-negative bacteria (30-40%), fungi (4.6-6%), and polymicrobial flora (12%) 1
  • Risk factors include prematurity, malignancy, previous abdominal surgery, and duration of PN use 1

Metabolic Complications

• Liver complications:

  • Elevated liver transaminases (hepatic steatosis progressing to steatohepatitis) 2
  • Cholestasis of varying severity 2
  • Incidence of hepatobiliary complications ranges from 20-75% in adults 3
  • End-stage liver disease occurs in approximately 15-20% of patients on prolonged PN 3

• Other metabolic disturbances:

  • Hyperglycemia and hyperosmolar states 4
  • Hyperlipidemia 4
  • Electrolyte imbalances 4
  • Refeeding syndrome 4

Bone-Related Complications

• Metabolic bone disease 4
• Reduced bone mineral density requiring monitoring and supplementation 1

Enteral Nutrition Complications

Gastrointestinal Complications

• Intestinal villous atrophy: Occurs due to lack of enteral stimulation when gut is not used 3, 5

  • This is a significant complication as it affects gut barrier function and can lead to bacterial translocation 3
  • Can be prevented by providing even minimal enteral nutrition alongside parenteral nutrition 5

• Other GI complications:

  • Diarrhea (most common GI disturbance) 6
  • Nausea and vomiting 6
  • Constipation 6

Mechanical Complications

• Tube displacement or dislodgement 6
• Tube obstruction 6
• Aspiration risk 6

Prevention Strategies

For Parenteral Nutrition

• Limit duration of PN use whenever possible 4
• Avoid overfeeding (particularly with lipids >1 g/kg/day) 2
• Cyclic infusion of PN when possible 1
• Maximize enteral nutrition when tolerated 1
• Use proper catheter care protocols to prevent infection 1

For Enteral Nutrition

• Confirm proper tube placement before feeding 6
• Use controller pumps for continuous feedings 6
• Regular flushing of feeding tubes 6
• Select appropriate formula (osmolality, nutrient content) 6
• Proper handling of formula to minimize contamination 6

Answer to Question

Based on the evidence presented, the most common complication of parenteral nutrition is catheter-related bloodstream infection (sepsis) (option A), while intestinal villous atrophy (option B) is a significant complication associated with lack of enteral nutrition. Elevated liver transaminases (option C) are also common but not as prevalent as sepsis. Hyperosmolar nonketotic coma (option D) can occur but is less common than the other complications mentioned.