Diarrhea with enteral feeding: will the real cause please stand up?

Article Abstract:

Diarrhea is common in patients who are fed enterally or through a tube passed through the nose into the stomach. The prevalence and causes of diarrhea associated with enteral feeding are not clearly known due to inconsistent methods of study and different definitions of diarrhea. A recent study examined the incidence of diarrhea over a 20-month period in patients receiving enteral feeding; diarrhea was clearly defined in terms of an excessive amount of stool. Tube-feeding was considered a cause of diarrhea, only if the diarrhea resolved when the enteral feeding was terminated. The incidence of diarrhea in enterally fed patients was 26 percent, with 21 percent of the cases of diarrhea directly related to enteral feeding, 62 percent related to medications, and 17 percent due to pseudomembranous colitis, or inflammation of the intestine with the formation of membranes on the mucosal lining of the intestinal cavity. The study also revealed that many elixirs or medicinal solutions contain large amounts of sorbitol, an alcohol used to sweeten solutions, which may cause the diarrhea. The use of one method, the stool osmotic gap, was also recommended for distinguishing whether diarrhea is caused by enteral feeding or disorders of intestinal secretions. Other possible causes of diarrhea associated with enteral feeding are described. The incidence of diarrhea with enteral feeding was increased with certain substances in the enteral formulas, antibiotic therapy, intestinal disorders, and low levels of blood proteins, but was decreased in patients receiving high-fiber enteral solutions. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Rapid improvement in dermatitis after zinc supplementation in a patient with Crohn's disease

Article Abstract:

Zinc is essential to human life and is involved in various cellular processes, such as protein and nucleic acid metabolism. A deficiency in zinc results from poor intake, abnormalities in absorption, kidney failure, liver disease, or a blood disorder called sickle cell disease, and is associated with various skin disorders. Zinc deficiency affects 35 to 45 percent of patients with Crohn's disease, the inflammation of the small intestines, and may result from long-term intestinal malabsorption, excessive loss of zinc due to diarrhea, and low dietary intake. A 58-year-old man was admitted to the hospital with diarrhea, lack of appetite, weight loss, and edema, or accumulation of body fluids. He had extensive dermatitis (an inflammation of the skin associated with itching), redness and skin lesions involving his entire body except the head and neck. Laboratory tests indicated decreased blood levels of several substances, including proteins, iron, zinc, and copper, and the man was diagnosed as having kwashiorkor, or protein deficiency, in addition to zinc deficiency. The patient was given total parenteral nutrition, the intravenous administration of nutrients, as well as zinc supplements. Within three to four days, the rash did not develop further, and it substantially resolved within two weeks. The patient later underwent surgical removal of the affected portion of the small intestine. The results show that zinc supplementation improves symptoms such as dermatitis associated with Crohn's disease.

Health aspects, Complications and side effects, Skin, Dermatitis, Zinc in the body, Zinc (Nutrient), Crohn's disease, Zinc deficiency diseases

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Diarrhea in tube-fed patients: feeding formula not necessarily the cause

Article Abstract:

The causes of diarrhea were studied in patients fed enterally, or by a tube passed through the nose and into the stomach. The methods for diagnosing diarrhea associated with enteral feeding were also assessed. Among 123 patients who received enteral feeding, 32 had diarrhea of greater than 500 milliliters (ml) per day over two consecutive days, and the overall incidence of diarrhea was 26 percent. A single cause of diarrhea could be specified in 29 of these cases, with 21 percent directly related to enteral feeding, 62 percent related to medications, and 17 percent due to bacterial infection with Clostridium difficile. The stool osmotic gap was an effective method for distinguishing whether the diarrhea was caused by osmotic factors, or the amount of undissolved particles in a solution that affect the passage of water between membranes. The results demonstrate that diarrhea in enterally-fed patients is not usually caused by the enteral formula. In addition, enterally fed patients often receive liquid medications that contain high amounts of the alcoholic sweetener sorbitol, which may be responsible for the diarrhea. An evaluation of medications and use of the stool osmotic gap method are the most effective techniques for diagnosing diarrhea associated with enteral feeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

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