Frequently Asked Questions on Enteral Nutrition


What is the procedure of storing enteral feeding formula?
  • Check the expiry date of your formula. Unopened cans of formula can be stored at room temperature for long periods of time
  • Cover open cans of formula and store them in the refrigerator between feedings. Do not use any open, unused cans of formula after 24 hours
What are standard feeds?

These feeds contain all the carbohydrate, protein, fat, water, electrolytes, micronutrients (vitamins and trace elements) and fibre required by a stable patient.

What are pre-digested feeds?
These contain nitrogen as short peptides or free amino acids and aim to improve nutrient absorption in the presence of pancreatic insufficiency or inflammatory bowel disease. The fibre content of these feeds is variable and some are supplemented with vitamin K, which may interact with other medications.
Nutrients such as glutamine, arginine and essential omega-3 fatty acids are able to modulate immune function. Enteral immunonutrition may decrease major infectious complications and length of hospital stay in surgical and some critically ill patients.
What is Re-feeding syndrome?
  • Re-feeding syndrome occurs in previously malnourished patients who are fed with high carbohydrate loads.
  • Carbohydrates (eg, glucose) in the feed can cause a large increase in the circulating insulin level. This results in a rapid and dramatic fall in phosphate, potassium and magnesium - with an increasing extracellular fluid (ECF) volume.
  • As the body tries to switch from catabolic (starvation mode) to using exogenous fuel sources, there is an increase in oxygen consumption, increased respiratory and cardiac workload (may precipitate acute heart failure and tachypnoea and make weaning from a ventilator difficult). Demand for nutrients and oxygen may outstrip supply. Both of the above can lead to multiple organ failure; respiratory and/or cardiac failure, arrhythmias, rhabdomyolysis, seizures or coma, red cell and/or leukocyte dysfunction.
  • The gut may have undergone some atrophy with starvation and, with the return of enteral feeding, there may be intolerance to the feed, with nausea and diarrhoea.
  • Feeds should be started slowly and the electrolytes closely monitored and adequately replaced to avoid these problems developing.