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Enteral Nutrition (EN): Management of Diarrhea Guideline

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Enteral Nutrition (EN): Management of Diarrhea Guideline . www.criticalcarenutrition.com. START. Stool output>3-5 liquid BM or >750 mL over 24 hr?. No. No Intervention. Yes. Distended, tympanic, or painful abdomen?. No. Medical/surgical hx consistent with diarrhea?

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slide1

Enteral Nutrition (EN): Management of Diarrhea Guideline

www.criticalcarenutrition.com

START

Stool output>3-5

liquid BM or >750 mL

over 24 hr?

No

No Intervention.

Yes

Distended, tympanic,

or painful abdomen?

No

Medical/surgical hx

consistent with diarrhea?

(see purple box)

No

Risk of stool impaction?

(see blue box)

No

Receiving cathartic

agents? (see orange

box)

No

Yes

Yes

Yes

Yes

Discontinue EN.

MD to review pt.

Medical intervention as indicated.

Rectal check; manual

disimpaction if positive.

Obtain abdominal x-ray

to rule out more proximal

impaction as indicated.

Change all oral liquid medications to

tablet or parenteral alternative;

change oral electrolyte solutions to

parenteral route; discontinue all

known cathartics (see orange box)

if possible.

IBD, terminal ileal resection, chemotherapy,

short bowel, chronic pancreatitis, new ileostomy.

Chronic constipation, absent BM x 5 day,

elderly, regular narcotic use, limited fluid intake.

Citromag®, docusate, Milk of Magnesia®

cascara, enema, hypertonic or sorbtol-

containg liquid medications, oral electrolyte

solutions, lactulose, Kayexalate®, prokinetic

agents, etc.

Rule out C. difficile infection,

bowel obstruction, bowel ischemia,

etc. If investigations negative,

consider a fiber- containing

enteral formulae.

No

Initiate antidiarrheal agent.

Reassess need/dose q 24 hr.

Diarrhea resolved?

Adapted from original work done by J. Greenwood, RD (Vancouver General Hospital) in collaboration with the Canadian CPG Panel (23/6/03)

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