Up to 26% of enterally fed patients report nausea and/or vomiting. If delayed gastric emptying is suspected as the causative factor, which of the following is LEAST likely to improve the patient's symptoms?

• A. Reduce or discontinue narcotic medications
• B. Switch to a low fat enteral formula
• C. Reduce the rate of enteral nutrition infusion
• D. Use a more concentrated enteral formula

Answer: (D)

Delayed gastric emptying causing nausea and vomiting is best managed by reducing gastric load and improving motility. Reducing narcotic use lowers medication-induced slowdown of the GI tract, which helps the stomach empty more normally. Switching to a low-fat enteral formula removes a known factor that slows gastric emptying, allowing faster clearance from the stomach and less distension. Reducing the rate of enteral nutrition infusion decreases the amount the stomach must process at any moment, giving it time to empty and reducing symptoms.

Using a more concentrated formula, while it delivers calories in less volume, increases the osmolar load and can worsen gastric irritation and delay, or at least not improve, symptoms. So it’s the option least likely to help.