Diarrhea with tube feeding

On the other hand, constipation may occur in some patients receiving tube feedings, especially the elderly. Increased provision of fluid or fiber may be useful in attaining bowel regularity. As with diarrhea, constipation maybe drug-related, in which case discontinuation or replacement of the offending drug may help to alleviate the problem. 

In general, oral supplements are not intended for tube feeding, but to enhance an oral diet. They are sweetened to improve taste and are therefore hypertonic (about 450 to 700 mOsm/kg). This is generally not a problem in the patient with a functioning GI tract. However, in the tube-fed patient, a sweetened product is not necessary and may contribute to GI intolerance, particularly diarrhea. Powder supplements that are mixed with milk should be avoided in lactose-intolerant patients. In addition to liquid supplements, puddings, gelatins, bars, and milkshake-like supplements are available. 

A general guideline for the estimate of calorie requirements of burned children is 60 calories per kg per day plus an additional 30 calories for each 100 cm of burned area. Burned children are often anorexic, have delayed gastric emptying, and develop diarrhea with duodenal tube feeding. Severe malnutrition is therefore a frequent complication (Blocker et al., 1955 Levenson et al., 1945 Sutherland and Batchelor, 1968) of patients with burn injury and is associated with protein breakdown,delayed wound healing and infection which further increase caloric demands. 

If a liquid dosage form of a medication exists, it would seem rational to use this dosage form for administration through a feeding tube. Although such a decision may decrease the potential for tube clogging, it may in some instances decrease tolerability of the medication administration. Sorbitol is an excipient found in many liquid medications in amounts sufficient to cause diarrhea. If diarrhea secondary to sorbitol in a liquid medication is suspected in a patient on EN, contact with the manufacturer to ascertain sorbitol content may be necessary. 

EN can be associated with important complications, such as nausea and vomiting (20%), gastroesophageal reflux, diarrhea (2-63%), malabsorption, aspiration (1 %), and tube malposition. Associated causes include duodenal ulcer, pyloric channel ulcer, ileus, anticholinergic medications, opiates, central nervous system disturbances, metabolic derangements, and severe protein deficiency. Treatment with a small intestine feeding tube—nasoduodenal or jejunostomy—may overcome the problem. Medications should be... 

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