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Diarrhea frequently develops in patients receiving tube feeding. It has been assumed that hyperosmolar feeding formulas are the principal cause, and that enteral formulas should initially be diluted to improve their tolerance. To test these assumptions, Edes and colleagues monitored 123 patients who received enteral feeding over a 20-month period. Documented diarrhea (more than 500 ml/day for at least two consecutive days) developed in 32 patients.
A single cause of diarrhea was found in 29 of the 32 patients, and tube-feeding formula was responsible in only six of these cases (21 percent). Medications (particularly elixirs with sorbitol) caused 61 percent of the cases, and Clostridium difficile caused 17 percent. A stool osmotic gap (stool …