Build Up Book Mark - 11/6/23

"It's not the Tube Feeding!" Guest Post, Top image (Words Matter), FREE CPEU and more!

GUEST POST: “It’s not the Tube Feeding!”

Emory University Hospital Clinical RD’s take on diarrhea

We spotted this thread on “X” (formerly Twitter) and asked Ashley DePriest if she could turn it into a post for the newsletter….

(Guest post by Ashley DePriest, MS, RDN, LD, CNSC, FCCM; Chelsi Snell, MS, RD, LD & Ben Steele, MS, RD, LD)

Diarrhea in tube-fed patients often gets blamed on the tube feeding, but we dietitians know that there are many other reasons a patient may have loose or increased stool. So, before you change the tube feeding think about:

What ARE some causes of diarrhea/loose stool for patients on tube feeding?

*Sorbitol

Many liquid medications contain sorbitol, a polyol and non-nutritive sweetener that, if not diluted properly, causes osmotic shifts and water, loose stool.

*Medications

Antibiotics, immunosuppressants, chemotherapy, lactulose, routine bowel regimens can all affect stool consistency.

*Stress

The stress of being sick and in the hospital can affect the GI system.

*C. diff (Clostridioides difficile)

Don’t forget to check the white count! And follow your hospital policies and protocols for sending C. diff samples.

*Anatomical Changes

Sometimes we forget to ask about past surgeries when patients are admitted for something seemingly unrelated. Short gut, previous bariatric or gastric surgery, or other GI surgeries can all change the way we digest and absorb nutrients.

Sources:

1. https://doi.org/10.1006/rtph.1999.1368,

2. https://doi.org/10.1097/mco.0b013e328363bcaf

3. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.12392?src=getftr

4. https://doi.org/10.1016/S0016-5085(49)80126-0

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669939/pdf/WJG-15-1554.pdf

6. https://doi.org/10.1053/j.gastro.2006.02.044

7. https://doi.org/10.1053/j.gastro.2016.10.014

8. https://doi.org/10.1080/08998280.2020.1712926

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514634/