Gut failure is associated with the inability to maintain energy, protein, carbohydrate, lipid, fluid, electrolytes, or micronutrient balances with volitional intake. Gut failure has numerous etiologies of both medical and surgical nature, but most the common is Short Bowel Syndrome (SBS), resulting from surgical resection. Gut failure can be defined as “symptoms and pathophysiologic state associated with inadequate nutrient assimilation as a result of surgical or medical etiology.” The primary goal in the management of gut failure is to achieve gut autonomy, obtaining adequate nutrient balance without parenteral nutrition (PN) supplementation. In addition to the macro and micronutrients provided by PN, fluid and electrolyte replacements are critical to success in attaining gut autonomy. Pharmacologic management must also be considered, and generally involves the use of antidiarrheal/antimotility medications, antisecretory medications, and mucosal growth factors. It should be noted that in situations of gut failure, PN should be considered early and anticipated to be a temporary solution to obtaining adequate nutrition, while concurrent attempts to utilize remaining viable intestine are made. When transitioning PN from hospital to home settings, it is essential that patients and family members providing support are educated on catheter care, infection prevention, hydration, electrolyte, and glycemic control, and the consequences resultant from failure to comply with instructions. Long-term PN use can result in a number of chronic conditions, including hepatic and biliary complications, catheter-related sepsis and thrombosis, renal dysfunction, memory deficit, and metabolic bone disease. Other treatments for gut failure include the use of Octreotide analogs, which have an antidiarrheal effect resulting in the reduction of fluid and electrolyte loss.
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