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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

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Considerations when administering medications enterally in the critically ill.

Robert MacLaren^1,2

¹Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

Current Opinion in Clinical Nutrition and Metabolic Care

|March 21, 2023

Summary

Enteral medication administration in critically ill patients requires careful consideration of gastrointestinal dysfunction and drug interactions. Understanding these factors is crucial for optimizing medication efficacy and patient safety when using enteral access devices.

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Area of Science:

Critical care medicine
Clinical pharmacology
Gastroenterology

Background:

Critically ill patients often experience gastrointestinal dysfunction, impacting drug absorption and bioavailability.
Enteral access devices (EADs) present unique challenges for medication administration.
Concurrent administration of medications with enteral nutrition can lead to errors and interactions.

Approach:

This review synthesizes current knowledge on factors influencing medication administration via EADs.
It highlights potential drug-drug and drug-nutrient interactions.
The impact of EAD characteristics and formulation on drug delivery is examined.

Key Points:

Gastrointestinal dysfunction in critical illness leads to variable drug absorption and bioavailability.
Liquid formulations, while preferred, can cause gastrointestinal distress due to hyperosmolarity or sorbitol.
EAD size and placement significantly affect drug dispersion, absorption, and pharmacokinetic profiles.

Conclusions:

Medication administration via EADs in critically ill patients can alter therapeutic effects, potentially diminishing efficacy or increasing toxicity.
Clinicians must recognize factors impacting bioavailability for enterally administered drugs.
Individualized assessment is necessary as medication effects vary significantly.