Tube Feeding Syndrome in Head and Neck Surgery

INCREASING sophistication in head and neck operative procedures frequently involves routine and often prolonged postoperative nasogastric feeding. The purpose of this paper is to call attention to a little recognized and sometimes dire complication of tube feeding. Hypernatremia and hypertonicity have been reported in a number of clinical conditions including primary neurologic disorders without renal disease,1nephrosis following sulfathiazole therapy,2solute diuresis,3transient diabetes insipidus following neurosurgical procedures,4during the recovery phase of diabetic acidosis,5head injury,4and diarrhea.3Welt et al described the role of the central nervous system (CNS) in the metabolism of electrolytes and water.6Schoolman et al7reported 100 cases of hypernatremia but did not implicate tube feeding as a factor or cause. In 1954, Engel and Jaeger8first described dehydration, hypernatremia, hyperchloremia, and azotemia as a complication of nasogastric tube feeding. This constitutes the tube feeding