Specialized nutrition support

Last updated: March 10, 2022

Summarytoggle arrow icon

Specialized nutrition support (SNS) is required when oral intake is either limited or not possible for a prolonged period of time. Common indications for SNS include patients in critical care, those with dysphagia, unconscious patients who cannot be fed, severely malnourished patients, and those with intestinal malabsorption. The two forms of SNS are enteral nutrition and parenteral nutrition. Enteral feeding is always preferred whenever possible, but parenteral feeding may be instituted if the patient has a nonfunctional GI tract (e.g., gastroschisis, short bowel syndromes), and/or if enteral feeding is contraindicated. Patients who are on SNS may develop several complications related to feeding tubes or intravenous catheters, as well as additional metabolic complications such as electrolyte imbalances, hyperglycemia, refeeding syndrome, gallstone disease, and nonalcoholic fatty liver disease.

References: [1]

The following principle applies in most situations: oral before enteral, enteral before parenteral!


Administration of nutrients directly into the stomach, duodenum, or jejunum with the help of feeding tubes

Indications [2][3]


Routes [2]

Composition of enteral feeding solutions


Enteral nutrition-associated respiratory failure [1][4][5]

Other complications [1][5]

Definition [1]

Indications for total parenteral nutrition [6]

Total parenteral nutrition should only be considered in patients without a functioning GI tract or when complete bowel rest is indicated.





Intestinal failure-associated liver disease (IFALD) [7]

Other complications

Metabolic complications are more common with parenteral nutrition than enteral nutrition!

  1. Pearce CB. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 2002; 78 (918): p.198-204. doi: 10.1136/pmj.78.918.198 . | Open in Read by QxMD
  2. Koretz RL. Enteral Nutrition: A Hard Look at Some Soft Evidence. Nutrition in Clinical Practice. 2009; 24 (3): p.316-324. doi: 10.1177/0884533609335378 . | Open in Read by QxMD
  3. Kulick, Deen. Specialized Nutrition Support. Am Fam Physician. 2011; Volume 83 (Number 2).
  4. Pingleton SK. Enteral nutrition in patients with respiratory disease. European Respiratory Journal. 1996; 9 (2): p.364-370. doi: 10.1183/09031936.96.09020364 . | Open in Read by QxMD
  5. Kogo M, Nagata K, Morimoto T, et al. Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure. Respir Care. 2016; 62 (4): p.459-467. doi: 10.4187/respcare.05003 . | Open in Read by QxMD
  6. Maudar K. Total parenteral nutrition. Med J Armed Forces India. 1995; 51 (2): p.122-126. doi: 10.1016/s0377-1237(17)30942-5 . | Open in Read by QxMD
  7. Carter BA, Shulman RJ. Mechanisms of Disease: update on the molecular etiology and fundamentals of parenteral nutrition associated cholestasis. Nature Clinical Practice Gastroenterology & Hepatology. 2007; 4 (5): p.277-287. doi: 10.1038/ncpgasthep0796 . | Open in Read by QxMD
  8. Carter B, Karpen S. Intestinal Failure-Associated Liver Disease: Management and Treatment Strategies Past, Present, and Future. Semin Liver Dis. 2007; 27 (3): p.251-258. doi: 10.1055/s-2007-985070 . | Open in Read by QxMD

3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer