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Enteral Nutrition (EN): Management of Diarrhea Guideline

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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Enteral Nutrition (EN): Management of Diarrhea Guideline

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  1. 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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