Contraindications to nutrition support in critically ill patients

	Notes
Enteral nutrition
Hemodynamic instability/shock	This applies mostly to patients who have not had their intravascular volume fully resuscitated since such patients may be predisposed to bowel ischemia
Bowel obstruction
Severe and protracted ileus
Major upper gastrointestinal bleeding	This does not apply to patients with milder gastrointestinal bleeding, such as coffee grind emesis
Intractable vomiting	Enteral nutrition may be started when vomiting settles
Gastrointestinal ischemia
High-output gastrointestinal fistula
Abdominal compartment syndrome
Parenteral nutrition
Severe hyperglycemia	Parenteral nutrition can be started once blood glucose is under control
Severe electrolyte abnormalities
Volume overload
Inadequate intravenous access	A limited, less hyperosmolar form of parenteral nutrition may be administered for short periods (peripheral parenteral nutrition)
Inadequate attempts to feed enterally

* Parenteral nutrition is only administered under the supervision of an expert (eg, nutritionist, pharmacist).

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