Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute complication of assisted intake
Aspiration with respiratory compromise, pulmonary oedema, line sepsis, tube displacement into the airway, severe electrolyte shift or refeeding syndrome can be life threatening. Assisted treatment must not continue automatically while harm is assessed.
Action: Use ABCDE assessment, stop the feed or fluid causing suspected harm, check glucose and relevant electrolytes, verify tube position and obtain urgent respiratory, nutrition, renal or critical-care help within the agreed ceiling. Treat aspiration, sepsis, overload and electrolyte deficits under the appropriate pathway and reassess whether the intervention still meets its goal.
Synopsis
Separate mouth care and supported oral intake from medical hydration and nutrition, identify reversible swallowing or metabolic problems, set a measurable goal for any assisted treatment and make lawful shared decisions to start, continue, withhold or stop it.
Offer safe sips, preferred tastes, eating assistance and frequent mouth care whenever wanted; reduced intake in dying is not corrected reliably by pressure to eat or automatic fluid.
Clinically assisted hydration includes intravenous, subcutaneous and enteral fluid; clinically assisted nutrition includes tube and parenteral feeding. Both are medical treatments requiring indication, consent and review.
First-line assessment identifies thirst, delirium, dysphagia, aspiration, nausea, obstruction, fluid losses, medicine effects, prognosis and the outcome the person wants treatment to achieve.
Key red flags
Cough, desaturation, wet voice or respiratory distress during feeding suggests aspiration and requires immediate cessation and assessment.
Refeeding syndrome
New oedema, tachycardia, weakness, confusion, arrhythmia or respiratory failure after restarting nutrition may reflect dangerous phosphate and electrolyte shifts.
Investigation priorities
01
First-line goal and intake assessmentFirst stepFirst line
Clarify desired outcome, appetite, actual intake, assistance, symptoms, cultural meaning, prognosis and burdens acceptable to the person.
Management branches
Supported oral careMaximise safe enjoyment and comfort
The person wants oral intake and can swallow some food, fluid or tastes with acceptable risk.
Treat mouth pain, candidiasis, nausea and constipation, provide upright assistance and offer small preferred textures and fluids without pressure.
Discuss aspiration and enjoyment openly, including a documented risk-feeding plan when the person chooses oral intake despite known risk.
Key medicines
Thiamine for high refeeding riskGive oral thiamine 200 to 300 mg daily immediately before and during the first 10 days of feeding, with the multivitamin and electrolyte plan specified by NICE CG32; use parenteral replacement when oral absorption is unreliable.
Electrolyte replacement during refeedingReplace potassium, phosphate and magnesium using the NICE CG32 risk ranges and the local intravenous or oral protocol, adjusted to measured values, renal function, ECG and fluid status.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.