Feeding the ICU Patient

Supportive Care & Reference · ICU Decoded chapter 87 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to ASPEN/SCCM 2016; ESPEN 2019.

Key points

When the gut works, start enteral feeding early (24–48 h): gastric route first, trophic 10–20 mL/h, then advance.
Protein ~1.3 g/kg/day (ESPEN 2023; up to 2 g/kg in selected patients); hypocaloric the first week, then 25–30 kcal/kg/day, using indirect calorimetry where available.
Refeeding risk in starved/alcoholic patients: start low, replace PO₄/K/Mg + thiamine, follow PO₄ daily.
TPN only when enteral feeding is contraindicated; do not hold feeds for gastric residual volume alone below 500 mL.

Investigations

First tests: Clinical nutrition and refeeding-risk assessment, Sodium, potassium, bicarbonate, urea and creatinine, Magnesium, Phosphate, Blood glucose.

Only if indicated: Liver biochemistry, Triglycerides.

Repeat monitoring: Potassium, magnesium and phosphate, Blood glucose.

Management pathways in this chapter

Choosing Feeding Route and Starting Feeds

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Why and when to send each test

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