Management

Correctable underlying causes of gastric retention (e.g. electrolyte abnormality, pain) should be treated, but gastric emptying is often slow to improve. Acute gastric dilatation

Treatment is gastric aspiration, continuous gastric drainage, and replacement of fluid and electrolytes. Promotion of gastric emptying

Gastric residual volumes can be affected by patient position; they are usually lowest when the patient is lying on the right side with the pylorus dependent, and greatest when lying on the left side. If residual volumes remain large after the patient is positioned right side down, prokinetic agents are given, for example intravenous metoclopramide 10 mg every 6 h, domperidone 10 to 20 mg orally or 30 to 60 mg rectally every 4 to 8 h, and cisapride 10 mg via the nasogastric tube every 6 h. Only cisapride has been shown to reduce gastric residual volumes significantly in critically ill patients. Erythromycin is prokinetic, but the high frequency of nausea often makes it unsuitable.

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