18th July 2023

A 26-year-old female patient with a past medical history of hypermobile Ehlers-Danlos syndrome

A 26-year-old female patient with a past medical history of hypermobile Ehlers-Danlos syndrome and gastroparesis presents to the hospital with a 3-month history of nausea and vomiting. She is only able to tolerate small sips of water and vomits with any food. On examination, she is clinically dehydrated, and her bloods are consistent with an acute kidney injury. Her weight today is 45kg and was 53kg when recorded in a Rheumatology clinic 6 months ago. Her BMI is 16.9. A previous colonoscopy and OGD with gastric and duodenal biopsies were normal. Gastric emptying studies reveal markedly delayed gastric emptying with preserved duodenal motility with no evidence of obstruction. An abdominal x-ray is taken, which is normal.

She is admitted under the gastroenterology team and is treated with intravenous fluids for her acute kidney injury. She is started on subcutaneous metoclopramide and intravenous erythromycin, but despite this, she is still unable to tolerate any oral diet after 3 days.

Which of the following routes of nutrition is most appropriate?

Select the SINGLE most appropriate option from the list below. Select ONE option only.