Nutritional support

Enteral feeds

Brand names: various — Fresubin, Nutrison, Ensure, Jevity

Adult dose

Dose: Individualised — starter regimen typically 20–40mL/h, increasing to target ~25–35 kcal/kg/day per BAPEN

Route: NG / NJ / Gastrostomy / Jejunostomy

Frequency: Continuous, intermittent, or bolus

Clinical pearls

NICE CG32 / NG189: nutrition support
BAPEN refeeding syndrome guidance — start at 5–10 kcal/kg/day if at risk; supplement thiamine, B-vitamins, electrolytes
NPSA NG-tube placement — pH check or X-ray before each feed/medication

Contraindications

Mechanical bowel obstruction
Severe ileus
Bowel ischaemia
Distal high-output fistula
Refractory shock

Side effects

Refeeding syndrome (hypophosphataemia, hypokalaemia, hypomagnesaemia)
Tube blockage/displacement
Aspiration
Diarrhoea
Constipation
Hyperglycaemia

Interactions

Phenytoin (reduced absorption — break feed before/after)
Levothyroxine
Ciprofloxacin (binding)

Monitoring

U&E
Phosphate
Magnesium
Glucose
Tube position
Daily fluid balance
Refeeding bloods

Reference: BNF; NICE CG32; NICE NG189; BAPEN; NPSA NG tube alert; https://bnf.nice.org.uk/drugs/enteral-feeds/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways