What complication is most likely when enteral feeding is initiated in a patient with decreased consciousness?

When enteral feeding is initiated in a patient with decreased consciousness, aspiration pneumonia is the complication most likely to occur. Decreased consciousness can impair the swallow reflex and the ability to protect the airway, leading to an increased risk of aspirating food particles or liquid into the lungs. This aspiration can cause an inflammatory response and infection, resulting in aspiration pneumonia.

In patients who are less alert, the usual protection mechanisms against aspiration—such as coughing or the coordination of swallowing—are diminished, making the feeding process inherently risky. As a consequence, the likelihood of food or formula entering the trachea increases, which can lead to respiratory complications like aspiration pneumonia.

Other potential complications, such as respiratory failure, electrolyte imbalance, and hyperglycemia, can occur in patients receiving enteral nutrition but are not as directly linked to the decreased level of consciousness. For example, respiratory failure could occur due to many factors unrelated to enteral feeding, and electrolyte imbalances often arise from the composition of the formula rather than from the act of feeding itself. Hyperglycemia can result from nutritional interventions but is generally managed through careful monitoring and adjustments rather than being an immediate risk associated with decreased consciousness during feeding.