Multiorgan failure from the inadvertent intravenous administration of enteral feeding

Nasogastric tube-feeding was inadvertently administered parenterally to a 65-year-old woman with chronic lymphocytic leukemia. Administration was discontinued after approximately 8 hr of infusion. The patient manifested acute renal failure, respiratory failure, hepatic insufficiency, and high-output septic shock requiring invasive hemodynamic monitoring, peritoneal dialysis, mechanical ventilation, and broad spectrum intravenous antibiotics. Blood cultures were positive for alpha-hemolytic Streptococcus, Staphylcoccus epidermidis, and Enterobacter cloacae while cultures of the enteral solution grew alpha-hemolytic Streptococcus, S. epidermidis, Pseudomonas vesiculare and unidentifiable coliforms. Aggressive management resulted in hospital discharge, although she eventually died of recurrent pneumonia and septicemia 111 days after the infusion. It is of paramount importance to be cognizant of this potential complication in any patient receiving enteral feeding who presents with the clinical picture of high-output septic shock. We discuss clinical features as well as treatment modalities necessary for a positive outcome.