Edes T E, Walk B E, Austin J L
Department of Medicine, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri 65201.
Am J Med. 1990 Feb;88(2):91-3. doi: 10.1016/0002-9343(90)90454-l.
This study of diarrhea in tube-fed patients was undertaken to determine the proportion of cases in which feeding formula is not responsible for the diarrhea, the causes other than the feeding formula, and the diagnostic approach to diarrhea in tube-fed patients.
Inpatients at the Truman Memorial Veterans Hospital who received nasoenteric feeding during the time period from October 1986 through May 1988 were eligible for this study. Of 123 patients who received nasoenteric feeding, 32 patients had documented diarrhea (greater than 500 mL per day for at least two consecutive days) and were enrolled. Three of these patients received hypertonic feeding formula, whereas the remaining 29 received isotonic feeding formula. Prospective determinations of the causes of diarrhea were performed. Laboratory tests included fecal leukocytes, stool osmolality, stool electrolytes, and Clostridium difficile toxin assay. Diarrhea was considered osmotic if the stool osmotic gap was greater than 100 mmol/L. Clinical management involved reducing or stopping the feeding formula, stopping suspected medications, or administering appropriate antibiotics.
There were 32 episodes of diarrhea in tube-fed patients during the study period. A single cause could be specified in 29 cases. The tube feeding formula was responsible for diarrhea in only 21% of these cases. Medications were directly responsible in 61% and C. difficile in 17% of cases. Stool osmotic gap correctly distinguished osmotic from non-osmotic diarrhea in all cases.
When diarrhea develops in properly tube-fed patients, the feeding formula is usually not responsible for the diarrhea. Patients receiving nasoenteric tube feeding are frequently placed on liquid forms of medications. Many medicinal elixirs contain sorbitol, which is often the cause of diarrhea in tube-fed patients. Review of the medications and determination of the stool osmotic gap are the initial diagnostic steps of highest yield.
开展这项关于管饲患者腹泻的研究，以确定腹泻病例中与喂养配方无关的比例、除喂养配方外的其他病因，以及管饲患者腹泻的诊断方法。
1986年10月至1988年5月期间在杜鲁门纪念退伍军人医院接受鼻肠喂养的住院患者符合本研究条件。在123例接受鼻肠喂养的患者中，32例有记录的腹泻（连续至少两天每天腹泻量大于500毫升）并被纳入研究。其中3例患者接受高渗喂养配方，其余29例接受等渗喂养配方。对腹泻病因进行前瞻性判定。实验室检查包括粪便白细胞、粪便渗透压、粪便电解质及艰难梭菌毒素检测。如果粪便渗透压差大于100 mmol/L，则认为腹泻为渗透性腹泻。临床处理包括减少或停止喂养配方、停用可疑药物或给予适当抗生素。
研究期间管饲患者出现32次腹泻发作。29例可明确单一病因。这些病例中仅21%的腹泻由管饲配方引起。61%的病例直接由药物引起，17%由艰难梭菌引起。粪便渗透压差在所有病例中均能正确区分渗透性腹泻与非渗透性腹泻。
在管饲恰当的患者发生腹泻时，喂养配方通常不是腹泻的原因。接受鼻肠管喂养的患者常使用液体制剂药物。许多药用酏剂含有山梨醇，这常常是管饲患者腹泻的原因。审查用药情况及测定粪便渗透压差是最有价值的初始诊断步骤。
