A 50-year-old gravida 0 para 0 woman underwent total abdominal hysterectomy 3 days ago. Initially, she was placed on a clear liquid diet to advance as tolerated starting on postoperative day 2. She now complains of nausea and has vomited several times. She has not yet passed flatus or stool. On examination, her abdomen is distended and bowel sounds are hypoactive. Laboratory values show a potassium level of 3.3, otherwise the remaining values are within normal limits. Abdominal flat plate radiograph demonstrates gas throughout the small and large intestine. Computed tomography scan is negative for bowel obstruction. Which of the following is a known risk factor for this postsurgical complication? hypokalemia, gum chewing, early carb intake or discontinue opioids
