Sorbitol diarrhea with

Of particular importance in the geriatric patient Weakness, lethargy, dysphoria, inability to concentrate, irritability, dysarthria, dizziness, peripheral neuropathy (dose-related), asymptomatic increase of LFTs, decreased appetite, lupus-like syndrome diarrhea with liquid preparations that contain sorbitol... 

Many healthy individuals are intolerant of sorbitol, and develop abdominal cramping and diarrhea with less than the usual laxative dose (23). It has been suggested that more than 30% of healthy adults, irrespective of ethnic origin, cannot tolerate 10 g of sorbitol (24). 

EHEC belonging to serotype 0157 H7 characteristically do not ferment sorbitol, whereas more than 70% of intestinal floral f. coli do. To properly screen EHEC strains in cases of diarrhea, stool should be placed on special sorbitol-MacConkey agar. Colonies of f. coli 0157 H7, which do not ferment the sorbitol, can be identified readily and confirmed by serotyping with specific antisera. In addition, stool should be tested directly for the presence of Stx I and II by enzyme immunoassay (EIA). 

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. 

Sodium polystyrene sulfonate is a cation-exchange resin suitable for asymptomatic patients with mild to moderate hyperkalemia. Each gram of resin exchanges 1 mEq of sodium for 1 mEq of potassium. The sorbitol component promotes excretion of exchanged potassium by inducing diarrhea. The oral route is better tolerated and more effective than the rectal route. 

Bacterial fermentation of sorbitol in the large bowel is associated with increased flatulence and abdominal cramping. Sorbitol 10 g can cause flatulence and bloating, and 20 g abdominal cramps and diarrhea. 

Saline laxatives (magnesium citrate, magnesium sulfate, sodium sulfate, and disodium phosphate) or saccharide laxatives (sorbitol, mannitol, lactulose) are also used in poisoned patients. Common adverse effects are abdominal cramps, excessive diarrhea, and abdominal distension. Dehydration and electroljde imbalance in children, and hjrpermagnesemia and magnesium toxicity (with magnesium-based cathartics) have also been reported. 

The delivery of medications to patients with SBS may present many challenges, not the least of which is the questionable absorption of oral therapies. It is important to avoid oral products that contain sorbitol or mannitol as inactive ingredients to avoid medication-related diarrhea. Loperamide and octreotide may be used to control diarrhea (see Chap. 36), and proton pump inhibitors and H2-receptor antagonists are frequently required to reduce gastric hypersecretion (see Chap. 33). 

F. Repeat-dose activated charcoal. Repeated doses of activated charcoal (20-30 g or 0.5-1 g/kg every 2-3 hours) are given orally or via gastric tube. The presence of a slurry of activated charcoal throughout several meters of the intestinal lumen reduces blood concentrations by intermpting enterohep-atic or enteroenteric recirculation of the dmg or toxin, a mode of action quite distinct from simple adsorption of ingested but unabsorbed tablets. This technique is easy and noninvasive and has been shown to shorten the half-life of phenobarbital, theophylline, and several other dmgs (Table 1-41). However, it has not been shown in clinical trials to alter patient outcome. Caution Re-peat-dose charcoal may cause serious fluid and electrolyte disturbance secondary to large-volume diarrhea, especially if premixed charcoal-sorbitol suspensions are used. Also, It should not be used in patients with ileus or obstmction. 

C. Diarrhea, dehydration, hypermagnesemia, and hypernatremia resulting from co-administered cathartics, especially with repeated doses of charcoal and cathartics, or even after a single large dose of a premixed, sorbitol-containing charcoal product. 

The inclusion of 10% or more of sorbitol in the diets of rats leads to diarrhea (Morgan and Yudkin, 1957). With 30% of sorbitol, this is so... 

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