The Nutritional Management of a Post COVID-19 Patient With Recurring High Gastric Residual Volumes: A Case Study

OBJECTIVES: This case study illustrates the nutritional assessment and management of a post Coronavirus disease-19 (COVID-19) patient with a recurring high gastric residual volume (GRV). Patients with COVID-19 can present with gastrointestinal (GI) symptoms that include a high GRV. The enteral nutrition (EN) guidelines regarding the management of high GRVs vary. The 2016 American Society of Parenteral and Enteral Nutrition (A.S.P.E.N) guidelines were followed. METHODS: Mr. X, a 67-year-old patient with multiple comorbidities, was admitted to our facility in mid December 2020 and discharged in mid July 2021. Two months after recovering from his COVID-19 infection, Mr. X presented with recurrent high GRVs. EN interventions included reduced feeding rates, use of elemental versus standard formulas, and fiber free versus fiber containing formulas. Other nutritional interventions included the use of parenteral nutrition for supplemental or total nutrition needs. The medical interventions included the management of blood glucose, electrolytes, and medications. The high GRVs continued during his prolonged hospital stay and on discharge despite different nutritional and medical interventions. RESULTS: Despite following the 2016 A.S.P.E.N guidelines in managing Mr. X's high GRV there were no clear reductions in the high GRVs. Our observations about GI disturbances in post-COVID-19 patients are supported by other studies. Even after addressing known factors that can contribute to a high GRV such as electrolyte imbalances and the use of hyperosmolar formulas, Mr. X continued to show high GRVs. CONCLUSIONS: The key learning point in this case study is that the patient did not experience the complications that would be anticipated due to GRVs at this magnitude. Neither did he respond as expected to recommended nutritional strategies. It is plausible that a high GRV is associated with post-COVID-19. The observation of an increased number of patients with post-COVID-19 GI complications has nutritional implications for clinical practice. Our study adds to the existing literature about the nutritional management of post-COVID-19 patients. FUNDING SOURCES: There were no funding sources.