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Enteral administration

Enteral administration refers to the delivery of medications, nutrients, or other substances directly into the gastrointestinal (GI) tract, encompassing routes such as oral ingestion, rectal insertion, or via enteral feeding tubes.^[1] This method leverages the natural digestive processes for absorption, providing a preferred route for systemic effects when patients are unable to swallow or require controlled delivery.^[1] Regulatory definitions such as the FDA's specify administration directly into the intestines, while broader medical usage encompasses entry into the GI tract, including oral routes, distinguishing it from parenteral methods that bypass the GI system.^[2] Common routes include oral (PO) administration, where tablets, capsules, or liquids are swallowed for gradual absorption over 30-60 minutes; rectal (PR) delivery via suppositories or enemas, which can achieve faster onset and higher bioavailability due to vascular drainage; and tube feeding, using devices like nasogastric (NG), nasointestinal (NI), or percutaneous endoscopic gastrostomy (PEG) tubes for patients with swallowing difficulties.^[1] For nutritional support, known as enteral nutrition, liquid formulas are administered through these tubes to the stomach or small intestine, often in home or clinical settings for conditions such as cancer, neurological disorders, or trauma that impair oral intake.^[3] Short-term tubes (e.g., nasogastric) are used for durations under 4-6 weeks, while long-term options like gastrostomy or jejunostomy involve surgical or endoscopic placement through the abdominal wall.^[4] Enteral administration is favored for its physiological compatibility, lower infection risk compared to intravenous methods, and cost-effectiveness, but requires careful verification of tube placement (e.g., via pH testing) and patient rights to prevent errors or complications like aspiration.^[1] Contraindications include recent GI surgery, bleeding, or hemodynamic instability, where initiation may be delayed until stability is achieved.^[1] Feeding modalities vary by setting: continuous infusion for critically ill patients in intensive care, intermittent or bolus feeds for home use or transitioning to oral intake, with head-of-bed elevation to 30-45 degrees recommended to minimize aspiration risk.^[4] Overall, it supports essential macro- and micronutrient delivery for those unable to meet needs orally, improving outcomes in malnutrition treatment.^[3]

Overview and Principles

Definition and Scope

Enteral administration refers to the delivery of drugs, nutrients, or fluids directly into the gastrointestinal (GI) tract, utilizing the digestive system for absorption and processing.^[1] This method encompasses various pathways that maintain the natural physiological functions of the GI tract, distinguishing it from invasive alternatives by preserving gut integrity and motility.^[5] The practice of enteral administration traces its origins to ancient civilizations, including the Egyptians, Indians, and Chinese around 3500 BC, where nutrient solutions were infused rectally or orally using herbal remedies and basic mixtures to treat illnesses.^[6] In modern pharmacology, it was formalized in the late 19th century with the development of standardized drug formulations, such as tablets and capsules, enabling more precise and reproducible dosing amid advancements in pharmaceutical manufacturing and regulatory oversight. In scope, enteral administration differs fundamentally from parenteral routes, which bypass the GI tract entirely (e.g., via intravenous injection), as it relies on the enteral pathway for systemic uptake while avoiding direct bloodstream entry.^[7] It applies broadly to both pharmacological interventions, such as oral tablets for medication delivery, and nutritional support, like tube feeds for patients unable to eat independently, thereby supporting therapeutic and sustenance needs within clinical practice.^[1] A core concept in this domain is bioavailability, defined as the fraction of the administered dose that reaches systemic circulation unchanged after GI absorption, which varies based on formulation and route specifics.^[8]

Basic Principles

Enteral administration relies on the anatomical structure of the gastrointestinal (GI) tract to facilitate the delivery of drugs and nutrients. The process begins in the mouth, where substances enter and may undergo initial dissolution or mucosal contact, followed by passage through the esophagus—a muscular tube approximately 25 cm long that propels contents via peristalsis to the stomach. The stomach serves as a reservoir with a capacity of about 1.5 liters, where mechanical mixing and gastric secretions prepare substances for further transit. The small intestine, spanning 4-6 meters with a vast surface area enhanced by villi and microvilli (approximately 200-250 m²), represents the primary site of absorption due to its extensive mucosal interface. Finally, the large intestine, about 1.5 meters in length, primarily reabsorbs water and electrolytes, with limited drug absorption occurring in its proximal regions.^[9]^[10] The general process of enteral administration involves two key stages: dissolution of the administered substance in GI fluids and subsequent permeation across the mucosal barriers. Upon ingestion, drugs or nutrients must first dissolve in the aqueous environment of the GI lumen to become bioavailable, a step influenced by the substance's solubility and the fluid volume present. Once dissolved, permeation occurs primarily through passive diffusion across the lipid-rich epithelial membranes of the GI mucosa, though carrier-mediated transport can play a role for certain compounds; this process is most efficient in the small intestine owing to its anatomical adaptations.^[11]^[9] Several physiological factors influence the efficacy of enteral delivery. pH gradients along the GI tract significantly affect dissolution and ionization states, with the stomach maintaining an acidic environment (pH 1-3.5) that can degrade sensitive compounds, while the small intestine shifts to a more neutral pH (6-7.5) conducive to absorption of many drugs in their non-ionized form. Transit time through the entire GI tract typically ranges from 24 to 72 hours, determining the duration of exposure to absorptive sites, whereas gut motility—driven by peristaltic waves and segmentation—modulates residence time and mixing, with accelerated motility potentially reducing absorption efficiency.^[9]^[10] Formulation strategies are essential to optimize enteral administration by addressing these physiological challenges. Dosage forms are engineered for controlled release, such as tablets or capsules with enteric coatings that resist dissolution in the acidic stomach and disintegrate in the higher pH of the intestines, thereby protecting acid-labile drugs like proton pump inhibitors and ensuring targeted delivery to absorption sites.^[12]^[9]

Routes of Administration

Oral Routes

Oral administration via swallowing represents the most common and convenient method for delivering medications enterally, involving the ingestion of solid forms such as tablets and capsules or liquid formulations like syrups and suspensions directly into the gastrointestinal tract. Tablets are compressed powders that disintegrate in the stomach to release the active ingredient, while capsules consist of a gelatin shell enclosing powdered or liquid drugs, offering protection from gastric acids or masking unpleasant tastes. Liquids provide rapid onset due to quicker dissolution but require precise measurement to ensure accurate dosing. This route is preferred for its simplicity and non-invasiveness, allowing patients to self-administer at home.^[13] For patients with swallowing difficulties, known as dysphagia, special considerations are essential to prevent aspiration or incomplete dosing; strategies include crushing tablets (if compatible) and mixing with thickened liquids or soft foods like applesauce, or opting for alternative liquid formulations to facilitate safer ingestion. Dysphagia affects approximately 16% of community-dwelling adults, with higher rates in the elderly, necessitating tailored administration techniques to maintain efficacy and safety. Clinical guidelines recommend assessing tablet crushability and vehicle compatibility to avoid altering drug release profiles.^[14] Sublingual administration involves placing a drug dosage, typically a tablet or film, under the tongue where it dissolves and is absorbed directly through the rich mucosal vasculature into the systemic circulation, bypassing the hepatic first-pass effect for faster onset. This method is particularly suited for potent drugs requiring rapid action, such as nitroglycerin used for acute angina relief, where peak plasma levels are achieved within 5 minutes post-administration. The sublingual mucosa's thin epithelium and high vascularity enable efficient permeation, though patients must avoid swallowing or eating to prevent GI uptake.^[15]^[16] Buccal administration entails positioning the dosage form, such as a tablet or lozenge, between the cheek and gum, allowing absorption through the buccal mucosa for controlled release over time. This route leverages the area's relatively immobile mucosa to sustain drug contact, reducing swallowing risks and enabling prolonged exposure, as seen with fentanyl buccal tablets for breakthrough cancer pain management in opioid-tolerant patients. Absorption occurs via passive diffusion, with bioavailability enhanced by avoiding enzymatic degradation in the GI tract; dissolution typically takes 15-30 minutes.^[17]^[18] Practical aspects of oral routes significantly influence therapeutic success, including dosing frequency, which is often daily or multiple times per day depending on the drug's half-life and formulation—extended-release tablets, for instance, allow once-daily dosing to improve adherence. Patient compliance is affected by factors like ease of swallowing and sensory attributes; poor palatability can lead to non-adherence rates up to 50% in pediatric populations. Common excipients, such as sweeteners (e.g., sucrose or aspartame) and flavorings, are incorporated to enhance taste and mask bitterness, thereby boosting acceptability without compromising stability.^[19]^[13]

Non-Oral Enteral Routes

Non-oral enteral routes provide alternative pathways for delivering medications and nutrients directly into the gastrointestinal tract, bypassing the oral cavity while utilizing the digestive system for absorption. These methods are particularly valuable for patients unable to swallow, such as those who are unconscious, have severe dysphagia, or require long-term nutritional support. Common approaches include rectal administration, nasogastric or orogastric tube insertion, and gastrostomy or jejunostomy tube placement, each involving specific devices and procedures to ensure safe delivery.^[5] Rectal administration involves inserting medications via the rectum, typically using suppositories or enemas, to achieve absorption through the rectal mucosa. The rectal mucosa's rich vascular supply enables rapid drug uptake via passive diffusion, with the surface area measuring 200–400 cm² in adults.^[20] This route partially avoids first-pass metabolism because the inferior and middle rectal veins drain directly into the systemic circulation, bypassing the liver for approximately 50% of the absorbed drug, while the superior rectal vein contributes to portal drainage.^[12] Suppositories are solid formulations inserted 2–4 cm into the rectum using a gloved, lubricated finger, with the patient positioned on their left side and knee bent to facilitate retention for 5–10 minutes post-insertion.^[12] Enemas, suitable for larger volumes, follow a similar positioning technique and are retained for absorption.^[12] This method is indicated for patients with gastrointestinal motility disorders or when oral routes are contraindicated, offering protection for acid-labile drugs.^[12] Nasogastric (NG) or orogastric tubes provide short-term access to the stomach by inserting a flexible, single- or double-lumen tube through the nose or mouth, respectively, via the esophagus.^[21] These tubes are used to administer liquid medications or enteral feeds, particularly in unconscious patients, those with impaired swallowing due to stroke, or individuals on mechanical ventilation.^[21] Placement is confirmed by X-ray, with the tube marked at the nares for depth tracking, and administration occurs via bolus (gravity) or continuous pump methods.^[21] Orogastric tubes, inserted orally, are preferred in intubated patients to avoid nasal trauma.^[5] For long-term access, gastrostomy or jejunostomy tubes are surgically or percutaneously placed directly into the stomach or jejunum, respectively, to deliver enteral nutrition or medications.^[22] Percutaneous endoscopic gastrostomy (PEG) tubes, a common type, are inserted using the "pull" technique under endoscopic guidance with moderate sedation, achieving a success rate over 95% after an 8-hour fast and prophylactic antibiotics like cefazolin.^[22] Jejunostomy tubes, often placed surgically (e.g., Witzel technique) or via percutaneous methods with a guidewire, are indicated for patients needing post-pyloric feeding to reduce aspiration risk or for those intolerant to gastric feeds.^[23] PEG-jejunostomy (PEG-J) extensions allow jejunal delivery through a gastric tube.^[22] These tubes support extended use beyond 4–6 weeks, with feeds initiating 6–12 hours post-placement in some cases.^[23] Procedural maintenance for all enteral tubes emphasizes hygiene and patency to minimize complications. Tubes are flushed with 15–30 mL of water before and after each medication or feeding, and between administrations, using a 60-mL syringe to prevent clogging from viscous formulas or crushed tablets; sterile water is recommended for immunocompromised patients, though potable water suffices in most cases due to the gastrointestinal tract's natural defenses.^[1]^[24]^[25] Medications should be given individually in liquid form or dissolved, avoiding mixtures that could precipitate.^[1] If clogging occurs, initial unclogging involves gentle irrigation with 20 mL lukewarm water using back-and-forth syringe motion, escalating to enzymatic solutions like pancreatic enzymes in sodium bicarbonate if needed.^[24] Risks include tube displacement from coughing or vomiting, checked every 4 hours via marking or pH testing, and infections like aspiration pneumonia, with clogging occurring in 25-35% of cases.^[21]^[22]^[26] Proper site care, such as daily rotation post-healing and sterile technique during changes, further reduces wound infections and buried bumper syndrome in ostomy tubes.^[22] These protocols help prevent gut atrophy in patients reliant on enteral support.^[5]

Pharmacokinetics

Absorption Processes

Enteral administration primarily involves the uptake of substances through the gastrointestinal (GI) tract, where the small intestine serves as the dominant site for absorption due to its expansive surface area and optimal physiological conditions. The small intestine's mucosal lining is amplified by villi and microvilli, creating a surface area estimated at 200 square meters, which facilitates efficient drug transfer into the bloodstream.^[27] Additionally, the neutral to slightly alkaline pH in the small intestine (approximately 6-7.5) promotes the ionization and solubility of many compounds, enhancing their permeability across the epithelial barrier compared to the acidic stomach environment.^[28] Absorption mechanisms in the GI tract vary based on the physicochemical properties of the administered substance. For lipophilic drugs, passive diffusion predominates, allowing molecules to cross the lipid-rich cell membranes of enterocytes down their concentration gradient without energy expenditure.^[29] In contrast, hydrophilic substances often rely on paracellular transport, passing through tight junctions between epithelial cells, though this pathway is limited to smaller molecules due to the junctions' selectivity.^[30] Active transport mechanisms, such as carrier-mediated systems for nutrients like amino acids, enable the uptake of specific drugs (e.g., levodopa via amino acid transporters) against concentration gradients, requiring ATP hydrolysis for energy.^[27] Several factors influence the efficiency of enteral absorption, including drug solubility as categorized by the Biopharmaceutics Classification System (BCS). The BCS divides drugs into four classes based on solubility and permeability: Class I (high solubility, high permeability) exhibits rapid absorption, while Class IV (low solubility, low permeability) faces significant barriers.^[31] Food intake can delay gastric emptying, prolonging exposure to stomach acids and altering dissolution rates, particularly for BCS Class II drugs where increased bile secretion may enhance solubility.^[32] Enzymatic degradation further complicates absorption; for instance, peptidases in intestinal secretions hydrolyze peptide bonds in protein-based drugs, reducing their bioavailability before they reach absorptive sites.^[33] Passive diffusion, the most common mechanism, is quantitatively described by Fick's first law of diffusion, which states that the flux (J) of a drug across the intestinal membrane is proportional to the concentration gradient. This relationship is expressed as:

J = -D \frac{dc}{dx}

where J represents the diffusive flux, D is the diffusion coefficient dependent on the drug's molecular size and membrane properties, and \frac{dc}{dx} denotes the concentration gradient across the epithelium.^[34] This principle underscores how maintaining a steep gradient—through sustained luminal concentrations—maximizes absorption rates for passively transported substances.^[35]

First-Pass Metabolism

First-pass metabolism refers to the initial biotransformation of drugs absorbed from the gastrointestinal tract before they reach systemic circulation, primarily occurring in the intestinal mucosa and liver.^[36] In enteral administration, drugs enter the portal vein after absorption, subjecting them to hepatic metabolism via enzymes such as cytochrome P450 (CYP) isoforms, including CYP3A4 in both the gut wall and liver, which can significantly reduce the amount of active drug available systemically.^[36] This process is a key determinant of oral bioavailability, often necessitating higher doses for orally administered medications compared to parenteral routes.^[8] The extent of first-pass metabolism is quantified in the bioavailability formula F = f_a \times f_g \times f_h, where F is the overall oral bioavailability, f_a is the fraction of the dose absorbed across the intestinal epithelium, f_g is the fraction escaping intestinal metabolism, and f_h is the fraction surviving hepatic first-pass extraction.^[37] For drugs with high hepatic extraction ratios (e.g., >0.7), f_h is low, leading to substantial bioavailability reduction; this effect is exacerbated by gut wall metabolism for CYP3A4 substrates.^[36] Morphine exemplifies a drug with pronounced first-pass metabolism, exhibiting oral bioavailability of approximately 20-40% due to extensive hepatic glucuronidation and some intestinal contributions, requiring oral doses about three times higher than intravenous equivalents for equivalent analgesia.^[38] Other high first-pass drugs, such as propranolol, similarly show reduced efficacy orally unless metabolized fractions are pharmacologically active.^[36] Variability in first-pass metabolism arises from genetic polymorphisms in CYP enzymes, such as CYP2D6 poor metabolizers who exhibit reduced hepatic clearance and higher bioavailability for affected substrates like codeine (a prodrug activated via first-pass).^[39] Drug interactions further modulate this process; for instance, grapefruit juice inhibits intestinal CYP3A4, increasing bioavailability of substrates like felodipine by up to 300% through diminished gut wall metabolism.^[40] These factors underscore the need for personalized dosing in enteral therapy to account for interindividual differences.^[39]

Advantages and Limitations

Advantages

Enteral administration offers significant convenience and improves patient compliance due to its non-invasive nature, allowing self-administration in forms such as oral tablets or capsules, which is particularly suitable for outpatient and home settings.^[41] This route eliminates the need for specialized equipment or healthcare professional intervention, making it accessible for chronic therapy and reducing the burden on medical facilities.^[12] In terms of cost-effectiveness, enteral methods are substantially less expensive than parenteral alternatives, with daily costs averaging around $25 compared to over $90 for intravenous nutrition, primarily because they avoid the requirements for sterile preparations, trained personnel, and monitoring for complications like catheter infections.^[42] Studies have shown that enteral nutrition can reduce overall hospitalization expenses by approximately $1,600 per patient through shorter stays and fewer interventions.^[42] Physiologically, enteral administration supports gut health by maintaining mucosal integrity and stimulating natural digestive processes, which helps preserve the gastrointestinal barrier function and immunological defenses.^[5] Unlike parenteral routes, it lowers the risk of systemic infections associated with intravenous lines, with evidence indicating significant reductions in infectious complications (e.g., 35-54% relative reduction) in critically ill patients.^[42] Pharmacologically, enteral formulations enable sustained or timed-release mechanisms, allowing for prolonged drug delivery and better control over absorption profiles in the gastrointestinal tract.^[12] For nutritional purposes, it accommodates high-volume dosing without the volume restrictions of parenteral methods, facilitating comprehensive nutrient provision.^[5]

Limitations

Enteral administration is associated with variable bioavailability, primarily due to the first-pass effect, where drugs absorbed from the gastrointestinal tract undergo extensive hepatic metabolism before reaching systemic circulation, necessitating higher oral doses compared to intravenous administration for drugs like morphine and pentazocine.^[36] This variability is further exacerbated by food interactions, as enteral nutrition can bind to drugs or alter solubility, reducing absorption; for instance, continuous enteral feeding decreases phenytoin serum concentrations by three to four times through physicochemical reactions in the gut lumen.^[43] In patients with gastrointestinal disorders such as malabsorption syndromes, sepsis, or gastroparesis, impaired motility and altered pH further diminish bioavailability, leading to subtherapeutic drug levels despite standard dosing.^[43] Patient-related factors often render enteral administration unsuitable, particularly in cases of nausea or vomiting, which occur in 20-30% of recipients and increase the risk of complications like aspiration pneumonia.^[5] It is contraindicated in unconscious or comatose patients with hemodynamic instability or active gastrointestinal bleeding, as these conditions heighten the danger of aspiration pneumonia, reported in up to 89% of critically ill patients with tracheostomy and mechanical ventilation using nasogastric tubes, especially in supine positions.^[5] Dysphagia, while an indication for tube feeding in some contexts, paradoxically elevates aspiration risk if tube placement or feeding protocols are suboptimal, such as with high gastric residual volumes or bolus feeds exceeding 1,500 mL daily.^[44] Formulation challenges arise from the harsh gastrointestinal environment, where low pH (1.5-2.2) in the stomach degrades acid-labile drugs like peptides and insulin, reducing their stability and bioavailability.^[45] Enzymatic activity from pepsin and pancreatic secretions further inactivates sensitive compounds, necessitating protective coatings that may fail due to unpredictable gastric emptying.^[45] Compared to intravenous routes, enteral administration exhibits slower onset of action owing to delayed absorption across the gut mucosa and variable transit times, limiting its use in emergencies requiring rapid therapeutic effects.^[45] Additional risks include gastrointestinal irritation, such as peptic ulcers from crushed irritant drugs like NSAIDs (e.g., isotretinoin) administered via feeding tubes, which expose the mucosa directly to high concentrations.^[46] Drug-nutrient interactions in enteral feeds can cause tube occlusion in up to 95% of incompatible admixtures or alter drug efficacy, as seen with phenytoin binding to enteral proteins, reducing bioavailability by 72%.^[46] Diarrhea, affecting 45% of patients, may stem from drug excipients like sorbitol rather than the feed itself, complicating management.^[46]

Clinical Applications

Pharmacological Uses

Enteral administration serves as a primary route for delivering pharmacological agents, leveraging the gastrointestinal tract for absorption into the systemic circulation or local effects. The oral route is widely used for systemic medications, such as antibiotics like amoxicillin, which achieve effective blood levels for treating bacterial infections.^[1] Rectal administration, in contrast, is employed for both local actions, such as with laxatives, and systemic effects, including antiemetics like promethazine suppositories to manage nausea and vomiting when oral intake is not feasible.^[1]^[12] Across therapeutic categories, enteral routes support a range of drugs, including analgesics for pain relief, antihypertensives like lisinopril for blood pressure control, and antivirals for viral infections. Drugs with high enteral suitability include those formulated as liquids or crushable tablets, facilitating absorption without significant barriers, whereas extended-release or enteric-coated formulations exhibit low suitability due to risks of altered release profiles when crushed for tube administration.^[1]^[12] Oral doses for many enterally administered drugs require adjustments to account for first-pass metabolism in the liver, ensuring adequate bioavailability.^[36] In special populations, enteral administration is adapted for pediatrics using syrups or chewable forms administered via oral syringes to improve compliance and accuracy, while geriatrics often rely on crushed tablets delivered through feeding tubes to address dysphagia and polypharmacy challenges.^[1] Sublingual delivery, a variant of the oral route, provides rapid onset for acute relief in these groups, as seen with nitroglycerin for angina.^[12] Therapeutic drug monitoring is essential for enterally administered drugs with narrow therapeutic indices, such as certain antibiotics and antifungals, to verify plasma levels and prevent toxicity or subtherapeutic effects amid variable absorption.^[47]^[48] This practice is particularly critical in pediatrics and geriatrics, where physiological changes can further influence pharmacokinetics.^[47]

Nutritional Uses

Enteral nutrition is indicated for patients at risk of malnutrition, those recovering from surgery, or individuals with critical illnesses such as sepsis, burns, or trauma, where oral intake is insufficient but the gastrointestinal tract remains functional.^[5] Common scenarios include dysphagia, coma, or neuromuscular disorders that impair swallowing, as well as upper gastrointestinal obstructions.^[5] Formula types vary based on patient needs; polymeric formulas, which contain intact proteins, carbohydrates, and fats, serve as standard options for most patients with normal digestive function, while elemental formulas provide pre-digested nutrients to aid absorption in cases of malabsorption or severe gastrointestinal compromise.^[5] Administration protocols emphasize timely initiation and tailored delivery to meet nutritional requirements safely. Enteral feeding can be delivered via bolus method, providing 100-400 mL over 5-30 minutes several times daily, or continuously at rates of 20-50 mL per hour using an infusion pump, with continuous often preferred in critically ill patients to minimize intolerance.^[5] Caloric goals typically aim for 25-30 kcal/kg/day in stable patients, adjusted based on energy expenditure assessments, while protein targets range from 1.2-2.0 g/kg/day to support recovery.^[5] Delivery often occurs through tubes placed in non-oral routes such as nasogastric or gastrostomy, as detailed in relevant sections.^[5] Complications such as diarrhea, which affects up to 30% of patients on medical-surgical wards and 80% in intensive care units, often arise from hyperosmolar feeds and can be managed by slowing infusion rates, switching to fiber-enriched formulas, or addressing underlying causes like medications.^[5] Electrolyte imbalances, including risks of refeeding syndrome with hypophosphatemia or hypokalemia, require proactive monitoring and supplementation, particularly during the initial 48-72 hours of feeding.^[5] Transition to oral intake should be gradual, starting with small volumes as gastrointestinal tolerance improves and under the guidance of a multidisciplinary nutritional team to prevent setbacks.^[5] Evidence supports enteral nutrition over parenteral routes in patients with functioning gastrointestinal tracts, demonstrating reduced infectious complications, shorter hospital stays, and lower costs, though mortality differences are not consistently significant.^[49] The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines from the 2020s, including the 2022 clinical practice guidelines for critically ill adults, recommend initiation of nutrition support therapy, including enteral nutrition when feasible, within the first week of ICU admission, prioritizing it for its physiological benefits in maintaining gut integrity.^[50]

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May 29, 2024 · Drugs administered via these routes have improved bioavailability because they bypass the first-pass effect, making absorption and onset of ...<|control11|><|separator|>
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Advantages of enteral nutrition over parenteral nutrition - PMC
It is a strong and commonly held belief among nutrition clinicians that enteral nutrition is preferable to parenteral nutrition.
[43]
[PDF] To Hold (Enteral Feeding) or Not to Hold: That IS the Question
enteral in, withholding EN 1 hour before and after drug administration is associated with limited success in preventing levothyroxine malabsorption. In the ...
[44]
Enteral feeding: Indications, complications, and nursing care
Jan 11, 2017 · Patients with feeding tubes are at risk for such complications as aspiration, tube malpositioning or dislodgment, refeeding syndrome, medication ...<|separator|>
[45]
Advances in Oral Drug Delivery Systems: Challenges and ... - NIH
Feb 1, 2023 · However, the oral drug delivery system faces the harsh physiological and physicochemical environment of the gastrointestinal tract, which limits ...Missing: instability onset
[46]
Clinical nutrition and drug interactions - PMC - PubMed Central - NIH
The addition of drugs into enteral nutrition bags may result in occlusion of the tube, change in bioavailability of the nutrient or the drug, or alteration of ...
[47]
Therapeutic Drug Monitoring Is a Feasible Tool to Personalize Drug ...
Aug 17, 2020 · TDM in neonates is primarily used for antibiotics, antifungals, and antiepileptic drugs in clinical practice. TDM appears to be particularly ...
[48]
Antimicrobial therapeutic drug monitoring in critically ill adult patients
May 7, 2020 · This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and ...
[49]
Enteral versus parenteral nutrition in critically ill patients: an updated ...
Apr 29, 2016 · Overall, there was no difference in mortality between the two routes of nutrition. EN as compared to PN led to a significant reduction in the ...Subgroup Analyses · Study Identification And... · Additional Files
[50]
Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition
Summary of each segment: