NPO Management in Ileus
Yes, patients with ileus should be made NPO, as enteral nutrition is contraindicated during active ileus due to intestinal obstruction or severe dysmotility. 1
Initial Management
When ileus is diagnosed, immediately institute NPO status and begin supportive care:
- Stop all oral intake - both food and fluids should be withheld 1
- Initiate intravenous fluid resuscitation with maintenance fluids containing 70-100 mmol/day of sodium and up to 1 mmol/kg/day of potassium 2
- Correct electrolyte abnormalities promptly, particularly potassium, magnesium, and sodium, as these imbalances can worsen intestinal motility 2, 3
- Consider nasogastric tube placement selectively - use only therapeutically for patients with gross intestinal edema or significant gastric distention, not routinely 4, 2
Contraindications to Enteral Feeding
The ESPEN guidelines explicitly list ileus as an absolute contraindication to enteral nutrition, along with: 1
- Intestinal obstruction (mechanical or functional)
- Severe shock
- Intestinal ischemia
- High-output fistula
- Severe intestinal hemorrhage
Nutritional Support Strategy
For ileus expected to resolve within 7 days: 1
- Continue NPO status with IV fluid support only
- Monitor for return of bowel function (passage of flatus, bowel sounds, bowel movements) 5
For prolonged ileus (>7 days expected): 1
- Initiate parenteral nutrition (PN) as the sole nutritional intervention when enteral feeding remains contraindicated 1
- PN is mandatory and life-saving when gastrointestinal function cannot support enteral intake 1
- Continue PN until bowel function returns sufficiently to tolerate enteral intake 1
Monitoring for Resolution
Watch for these signs indicating readiness to advance from NPO: 5, 6
- Return of bowel sounds
- Passage of flatus
- Reduction in abdominal distention
- Patient reports hunger
- Absence of nausea/vomiting
Reintroduction of Enteral Intake
Once bowel function returns: 1, 4
- Begin with small amounts of clear liquids and advance as tolerated 4
- Transition to early oral nutrition within 24 hours of resolution when possible 4
- Discontinue PN when oral/enteral intake reaches approximately 50-60% of requirements 1
Critical Pitfalls to Avoid
Do not attempt enteral feeding during active ileus - this can worsen distention, increase intra-abdominal pressure, and lead to aspiration risk 7, 3. The intestinal dysmotility prevents effective transit and absorption, making enteral nutrition both ineffective and potentially harmful 7.
Avoid fluid overloading - excessive IV fluids can worsen intestinal edema and prolong ileus duration 2. Use balanced crystalloid solutions rather than excessive normal saline 8.
Do not delay PN in prolonged cases - if ileus persists beyond 7 days in a malnourished patient or is expected to last >7 days, initiate PN promptly to prevent further nutritional deterioration 1.