Nutritional support

In the vast majority of patients presenting with acute weakness the gastrointestinal system remains functional. Therefore parenteral nutrition is usually unnecessary. A

nasogastric tube should be inserted, or alternatively a percutaneous endoscopic gastrostomy tube may be used. There is little evidence that any particular enteral feed is superior in terms of outcome. However, it is important to ensure that sufficient quantities of nitrogen and calories are administered to overcome the negative balances of each associated with critical illness and immobility. If a tracheostomy tube has been inserted, it is usually possible to allow the patient to eat normally during the day, if necessary supplementing the oral diet with enteral feeding overnight. Severely weak patients are likely to be unable to feed themselves without help. Nursing staff and relatives should be encouraged to assist in the feeding of the patient.

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