We hope your feeding goes well but you should be aware of what to do if you cannot feed normally. This information provides you with advice for the most common situations.

Dehydration

Lack of fluid is the most immediate risk to your health if you are not able to get all your feed and water. This can include extended periods of hot weather, where there is a need to consider giving extra water via your tube, or as a complication of diarrhoea and vomiting.

Signs and symptoms of dehydration will be much more obvious and potentially dangerous than malnutrition – lack of food and/or feed.

The signs and symptoms of dehydration to look out for are:

• thirst
• dry skin
• dry mouth
• fatigue
• confusion
• headache
• strong smelling and/or dark urine – on the chart below, one to three is healthy wee. Four to eight and it’s time to hydrate.

If you have any of these symptoms, you may be dehydrated and having more fluid is essential.

Diarrhoea and vomiting

Sometimes you will not be able to absorb your feed well. This can cause diarrhoea and vomiting.  The causes of diarrhoea and vomiting can be because of a:

• change in medication e.g. antibiotics
• bacterial infection
• virus
• change in the way you are giving your feed
• recent change to a new feed.

If the cause is bacterial or viral then it is important to follow a 24-hour protocol of small, frequent fluids with less feed as a temporary measure.

You can also follow general guidance at www.nhs.uk/conditions/diarrhoea-and-vomiting/

Vomiting

Adults

• Stop feed for four hours and give small boluses of water by syringe, for example 20ml per 10 minutes.
• After four hours – if vomiting has stopped – increase the fluid bolus to 40ml per 20 minutes.

If you have difficulty keeping fluids down for more than 24 hours, please seek urgent medical advice from your GP.

• After 12 hours – if vomiting has stopped – start pump feed at half the usual pump speed and give bolus feeds at half volume, making sure to flush water with a syringe regularly in small amounts little and often.
• After 24 hours, you can try the feed rate at normal rate.

Children

Please follow the advice above but if you have already made any changes to your child’s regime, please contact us for further advice.

Diarrhoea

Adults and children

• It’s important to stay hydrated, even though you are having diarrhoea. Fluids (water) given little and often, for example 30 to 50ml per 30 minutes for four hours, will help initially.
• You may also benefit from a rehydration fluid, such as Dioralyte, and your GP will be able to prescribe this. Please follow the guidance on the packaging in relation to frequency and amount.

Hot weather

When it’s hot, our fluid requirements go up and it’s good to be aware of this and know what to do to avoid dehydration.

For more tips for looking after yourself in the heat visit www.nhs.uk/heatwave

Adults

In hot weather, an additional 300 to 500ml of water is recommended.

• For patients with a gastrostomy tube or nasogastric tube (NG) this additional water can be administered as five x 100ml water flushes per day.
• For patients with a jejunostomy tube or naso-jejunal (NJ) tube this additional boiled and cooled water can be administered as 10 50ml water flushes per day.

Along with this information, check your care plan as there may be more specific guidance for you on what to do in hot weather.

Children

For children, please give 100 to 200ml of additional water, spilt throughout the day while monitoring tolerance. Please contact us if you have any concerns or would like further advice.

What to do if you can't re-hydrate

If you are unable to re-hydrate after following this advice, you should seek urgent medical help.

If you have any type of diabetes, your risk of becoming severely unwell quickly is high and you should have an individualised care plan about what to do. Please speak to your diabetes nurse about this.

Storing your feed

The recommended storage conditions for unopened enteral feeding products is in a cool, dry place at five to 25°. During periods of unusually hot weather and if your normal storage location exceeds 25°, please try to move it to a cooler place.’

Helpful links

If you are unable to feed due to a water, power and/or delivery failure, please see our information about what to do in an enteral feeding emergency.

If your tube is blocked, please see our information about feeding tube blockages.

If your tube has come out, please see our information about what do to if your gastrostomy feeding tube comes out.