Nosocomial diarrhea: beware the medicinal elixir.

An unusual case of osmotic diarrhea that persisted despite fasting led to the discovery of an unexpected source of hospital-acquired diarrhea. Numerous patients were subsequently found to have onset of diarrhea shortly after the initiation of treatment with theophylline elixir. Although theophylline can promote gastrointestinal secretion and motility, this effect should be independent of the route of theophylline administration and the stool should be characteristic of secretory rather than osmotic diarrhea. Patients taking no food orally while taking theophylline elixir continued to have osmotic diarrhea in excess of 1,000 ml/24 hr. Patients whose therapy was switched to intravenous or solid oral theophylline had resolution of diarrhea within 24 hours. The brand of theophylline elixir used was formulated with 30 gm of sorbitol per 240 mg of theophylline; thus a standard regimen of theophylline elixir was delivering four laxative doses of sorbitol daily. A cursory review revealed that many medicinal elixirs are formulated with sorbitol, despite being designated "sugar-free." When patients have osmotic diarrhea in the hospital, beware the medicinal elixir.