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Gastrointestinal Management in Neurocritical Care
What bowel regimen should be used?
Docusate, senna, polyethylene glycol, bisacodyl, and lactulose on an as needed basis are acceptable medications used either individually or in combination.
How are nutrition and electrolytes managed?
• Nutritional support
This is indicated for any critically ill patient who cannot take oral feeds and in whom oral intake is not expected to cover the full energy needs.
There are two routes for nutrition administration in these patients, enteral and parenteral.
Enteral nutrition is always the first choice and should be started 24 hours after intensive care unit (ICU) admission if no procedures are planned.
Parenteral nutrition should be restricted to those situations in which there are contraindications to enteral nutrition.
• Electrolytes:
Electrolyte imbalances need to be worked up and corrected aggressively.
Refeeding syndrome must be recognized in severe protein–calorie malnutrition, bearing in mind that hypophosphatemia is the hallmark of biochemical abnormality.
Correction of hypophosphatemia should precede feeding.
