What if a patient on low intermittent suction of a Nasogastric (NG) tube experiences excessive output, with 980 cc output in a day?

Management of High NG Tube Output (980 cc/day)

An NG tube output of 980 cc in one day on low intermittent suction is within the expected range and does not require immediate intervention unless the patient develops electrolyte abnormalities, dehydration, or metabolic alkalosis. 1

Understanding Normal vs. Excessive Output

• Normal gastric secretion ranges from 1500-2500 mL per day, so 980 cc output over a full day is actually on the lower end of expected gastric drainage 2
• High-output situations typically refer to outputs exceeding 2 liters per day, particularly in conditions like short bowel syndrome where jejunostomy outputs can exceed 4 liters daily 3
• The patient's concern about "too much output" likely reflects discomfort or anxiety rather than a true clinical problem requiring suction adjustment 1

Key Management Priorities

Monitor for Metabolic Complications

• Check electrolytes, particularly bicarbonate, chloride, potassium, and magnesium, as gastric fluid loss causes metabolic alkalosis and electrolyte depletion 3, 2
• Rising plasma bicarbonate concentration indicates developing metabolic alkalosis from hydrogen and chloride loss 2
• Potassium, magnesium, and zinc losses increase with high gastric output and require monitoring and replacement 3

Assess Hydration Status

• Monitor urine output (should maintain at least 1 L/day), weight changes, and signs of thirst 3
• Calculate fluid balance accounting for NG output, oral intake, urine output, and insensible losses 3
• Patients may require additional intravenous fluids if output consistently exceeds intake 3

Pharmacologic Intervention to Reduce Output

Consider administering acid suppression therapy with H2-receptor antagonists or proton pump inhibitors to reduce gastric acid secretion and lower NG output 2

• Cimetidine 300 mg IV every 6 hours significantly reduces gastric acid output and prevents metabolic alkalosis associated with gastric fluid loss 2
• This approach addresses the underlying cause of high output rather than simply adjusting suction settings 2

When to Adjust or Remove Suction

• Do not discontinue or reduce suction based solely on output volume if the tube was placed for decompression of obstruction or gastric distention 1
• If the four-hour gastric residual exceeds 200 mL during feeding attempts, the feeding regimen should be reviewed rather than removing decompression 3
• Consider removing the NG tube only when the underlying indication (obstruction, ileus, aspiration risk) has resolved 1

Common Pitfalls to Avoid

• Do not assume high output means the suction is "too strong" - low intermittent suction is the standard setting and rarely causes excessive drainage 1
• Avoid having the patient drink large quantities of water to "feel better," as this paradoxically increases gastric output and worsens electrolyte disturbances 3
• Do not rely on patient discomfort alone to guide clinical decisions about NG tube management - objective assessment of the underlying condition is essential 1

Patient Education and Reassurance

• Explain that gastric secretion is a normal physiologic process and the tube is simply removing what the stomach naturally produces 2
• Reassure that 980 cc output does not indicate harm from the suction itself 1
• Address comfort measures: proper tube securing, nasal care, and mouth care to improve tolerance 1
• Consider specialized securing methods to prevent tube migration and reduce nasal discomfort 1, 4