When should enteral nutrition be initiated in the hemodynamically unstable patient?

• A. Immediately upon admission
• B. EN should be delayed until fluid resuscitation is complete
• C. After 72 hours regardless of status
• D. Only after vasopressor withholding for 24 hours

Answer: (B)

In patients who are hemodynamically unstable, the gut needs reliable blood flow to tolerate nutrition. During fluid resuscitation and ongoing vasopressor support, splanchnic perfusion can be variable, and starting enteral feeding too early risks gut ischemia, poor tolerance, and aspiration if ileus develops. Delaying enteral nutrition until the initial resuscitation is complete allows circulation to stabilize and perfusion to improve, making it safer to provide nutrition. Once stabilized, nutrition can be started cautiously and advanced as tolerated. Starting immediately, waiting a fixed 72 hours regardless of status, or only after a fixed vasopressor withholding period do not align with the need to balance restoring perfusion with providing necessary nutrition.