The paracetamol absorption test: a useful addition to the enteral nutrition algorithm?

Background: Enteral nutrition in critically ill patients given via the naso gastric route is often decreased or stopped because of large gastric residu al volumes. Aim: To assess the effect of continuing enteral nutrition in pa tients with an elevated gastric residual volume but normal gastric emptying by the paracetamol absorption test. Methods: The paracetamol absorption te st was performed on all patients receiving enteral nutrition via a nasogast ric tube who had a residual volume (assessed every 8 hours) of >150 ml or m ove than twice the hourly infusion rate. Patients were then divided into 2 groups according to the result of the test: Group 1 (n=8), normal gastric e mptying; and Group II (n=24), abnormal gastric emptying. Group I continued to receive enteral nutrition. In Group II feeding was interrupted in 18 pat ients and prokinetic agents administered, while a subgroup of six patients continued to receive enteral nutrition without prokinetic agents. All patie nts were followed for evidence of delayed gastric emptying and aspiration. Results: Residual volumes were similarly elevated in both groups (p=0.25). Enteral nutrition was continued in Group I with no adverse effects. Prokine tic agents allowed enteral nutrition to be resumed in 88% of the 18 Group I I patients. Enteral nutrition in the subgroup had to be stopped because of persistently elevated residual volumes. Conclusion: The paracetamol absorpt ion test may be normal in patients with relatively high gastric residual vo lumes. These patients may continue to receive enteral nutrition. (C) 2000 H arcourt Publishers Ltd.