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When to start oral feeding in a patient of stroke? Dr. Adil Ramzan


Dr. Adil Ramzan
A Patient who has a stroke commonly presents with altered sensorium, dysphagia, and weakness of a part or whole side of the body depending on the extent of infarct and area of the brain that is involved. If a patient has dysphagia or altered sensorium, then he is at risk of having aspiration. So in such situation, oral or enteral feeding shouldn't be allowed during the first 72 hours at least.

Professor Dr. Rauf Niazi, explained during a teaching session at PIMS hospital, "A nasogastric tube should only be passed if needed as it may actually increase the risk of aspiration. In the presence of nasogastric tube the lower esophageal sphinctor (a valve at the lower end of esophagus which prevents reflux of stomach contents back to esophagus) can't close properly and food or gastric secretions may regurgitate back to esophagus, thus, increase the risk of aspiration. If patient is at risk of aspiration or is having recurrent aspiration, then you should pass NG tube actively aspirate the gastric content with suction pump to keep the stomach empty so that there shouldn't be any gastric content left behind for regurgitation"

When to start oral feeding  in a patient of stroke?

Start feeding in a patient of if;
  1. Gag reflux is positive
  2. Patient passes swallowing test that is patient is able to swallow properly. 
  3. Patient is able to take sips. 
  4. Patient head end should be raised to 45 degrees or more during feeding. 
Nutrition is a main concern in a patient of stroke and it will be discussed in the upcoming articles.
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