A patient on long-term home enteral nutrition suddenly develops nausea and vomiting. The most likely cause is

• A. Gastric outlet obstruction
• B. Frequent sorbitol-containing medications
• C. Low osmolarity formula
• D. Sudden decrease in enteral feeding rate

Answer: (A)

When a patient on long-term home enteral nutrition suddenly has nausea and vomiting, think about something blocking the flow of contents from the stomach into the small intestine. A gastric outlet obstruction, which involves the pylorus or antrum preventing emptying of stomach contents, explains this pattern well because feeds can back up and trigger vomiting.

This is more consistent with the symptom than the other options. Medications containing sorbitol can irritate the GI tract, but they more often cause osmotic diarrhea or cramps rather than sudden vomiting. A low osmolarity formula tends to be better tolerated and is unlikely to cause abrupt vomiting. A sudden decrease in feeding rate might cause changes in tolerance, but it does not typically produce the characteristic vomiting from a blockage. If gastric outlet obstruction is suspected, signs like abdominal distension and high gastric residuals may be present, and imaging or clinical evaluation should be pursued to identify a mechanical cause such as pyloric or antral issues.