Is it recommended to hold two feedings and start normal saline 0.9% (normal saline) at 70 mL/hour in a patient with mild ileus who is taking very little by mouth (PO)?

Management of Mild Ileus in a Patient with Limited Oral Intake

Holding tube feeding and starting normal saline 0.9% at 70 mL/hour is appropriate management for a patient with mild ileus who has limited oral intake, along with monitoring bowel sounds, ordering laboratory tests, and repeating KUB imaging.

Fluid Management

• Isotonic intravenous fluids such as normal saline 0.9% should be administered when there is ileus, as this helps maintain hydration while the gastrointestinal tract recovers 1
• The recommended rate of 70 mL/hour is appropriate for maintenance fluid therapy while monitoring the patient's response 1
• Normal saline is preferred in this situation as it helps maintain electrolyte balance during periods of limited enteral intake 1
• Fluid management should be goal-directed, with attention to maintaining adequate hydration status 1

Nutritional Considerations

• Holding tube feeding is appropriate when a patient has ileus, as continued enteral feeding may worsen symptoms and delay recovery 1
• For patients with mild ileus, temporary cessation of enteral nutrition allows the bowel to rest 1
• Once bowel function returns (indicated by return of bowel sounds and passage of flatus), enteral nutrition can be gradually reintroduced 1
• In patients with intestinal obstruction or ileus, parenteral hydration is necessary until bowel function improves 1

Monitoring Parameters

• Regular assessment of bowel sounds every shift is essential to track recovery of bowel function 1
• Laboratory tests including Complete Metabolic Panel (CMP) and Complete Blood Count (CBC) help monitor for electrolyte imbalances and signs of infection 1
• Repeating KUB (Kidney, Ureter, Bladder) imaging the following day is appropriate to assess for resolution or progression of ileus 1
• Monitoring urine output and vital signs is also important to assess hydration status and response to therapy 1

Additional Considerations

• Avoid antimotility agents in patients with ileus as they may worsen the condition 1
• Maintain the patient in a position that promotes comfort and optimal respiratory function 1
• Once bowel sounds return and the patient shows signs of resolving ileus, oral or enteral feeding should be gradually reintroduced 1
• Sodium chloride 0.9% is preferred over heparin for flushing and locking central venous access devices if present 1

Potential Pitfalls and Caveats

• Be cautious with fluid administration in patients with cardiac or renal dysfunction, as excessive fluid may lead to volume overload 1
• Monitor for signs of electrolyte imbalances, particularly hypokalemia and hypomagnesemia, which can worsen ileus 1
• Avoid hypotonic fluids in patients with ileus as they may contribute to electrolyte imbalances 1
• If ileus persists beyond 48-72 hours despite conservative management, consider additional diagnostic workup to rule out mechanical obstruction or other complications 1