During hypertonic feedings, if intolerance develops, what should be done?

• A. Decrease the rate and continue with the schedule, then gradually increase again.
• B. Stop the feeding permanently.
• C. Increase the rate to accelerate tolerance.
• D. Switch to parenteral nutrition.

Answer: (A)

When intolerance occurs with a hypertonic enteral feeding, the immediate and best course is to slow the infusion rate to a level the gut can tolerate, while keeping the feeding schedule moving at that slower pace. This osmotic load can overwhelm the GI tract, causing symptoms like nausea, cramps, vomiting, or distension; reducing the rate minimizes these issues and gives the gut a chance to adapt. Once the patient tolerates the slower rate, gradually increase the rate in small steps and monitor closely for recurrence of symptoms. This approach preserves nutrition delivery and improves tolerance without jumping back to the original high rate. If intolerance persists despite rate reduction, reassess for other contributing factors and consider adjustments to the formula or feeding method; drastically stopping feeding or switching to parenteral nutrition are not first-line steps and are reserved for cases where enteral feeding cannot be tolerated despite optimization.