Clinical Nutrition

Enteral and Tube Feeding: If the Gut Works, Use It

Nutrition rarely makes the headline diagnosis, yet it quietly decides whether wounds heal, whether infections are fought off, and whether a patient walks out of hospital or lingers. A startling fraction of hospital patients are already malnourished on admission — and get worse on our watch, kept nil-by-mouth for tests that keep slipping. Feeding them again is not a hotel service; it is a therapy with its own rules, its own routes, and its own dangers. The first rule is almost a slogan: if the gut works, use it.

Parenteral Nutrition: Feeding Into the Vein

The first rule of feeding a sick patient is almost a reflex: if the gut works, use it. Enteral nutrition is cheaper, safer, and keeps the bowel alive. But sometimes the gut cannot be used at all — it is too short, too obstructed, too leaky, or too inflamed to absorb anything. For those patients, medicine does something that would have seemed impossible a century ago: it bypasses the digestive tract entirely and drips a complete diet — sugar, protein, fat, salts and vitamins — straight into a great vein near the heart. It is life-saving. It is also one of the most dangerous things you can hang on a drip stand, and the reason a whole team watches the patient every single day.

Refeeding Syndrome: When Feeding the Starved Becomes Dangerous

It is one of medicine's cruellest paradoxes: the treatment that should save a starving patient can be the thing that kills them. Give food too fast to a body that has spent weeks running on its own reserves, and the metabolic switch back to sugar unleashes a silent electrolyte collapse — phosphate, potassium and magnesium vanish from the blood in hours, the heart falters, the muscles fail. The danger is not the food itself but its speed. Understanding why turns a fatal mistake into a routine, preventable one.

Nutrition in Special States: Pregnancy, the Elderly, Vegans and Bariatric Surgery

Most of nutrition is the same for everyone: eat enough of the right things. But a handful of physiological states rewrite the rules. Pregnancy builds a second body from scratch. The ageing gut slowly stops absorbing what it always did. A plant-only diet omits one vitamin no plant can supply. And bariatric surgery deliberately bypasses the very stretch of bowel where iron, B12 and calcium are absorbed. In each case the same question returns with a different answer: which nutrient does this particular body now struggle to get — and which supplement fixes exactly that gap?