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Osmotic Diarrhea Induced by Sugar-Free Theophylline Solution in Critically III Patients

Department of Medicine, University of Kentucky Medical Center, Lexington Veterans Administration Medical Center, Lexington, Kentucky

Lisa M. Henderson, PHARM.D.

Nutrition Support Seruice, University of Kentucky Medical Center

Craig J. Mcclain, M.D.

Department of Medicine, University of Kentucky Medical Center, Lexington Veterans Administration Medical Center, Lexington, Kentucky

It is widely accepted that early enteral nutrition is beneficial to critically ill patients. Diarrhea is a common problem in this setting and is often erroneously ascribed to enteral feedings. More often medications cause the diarrhea. Multiple cases of severe diarrhea associated with the use of a sugar-free theophylline solution (SFTS) were discovered by a nutrition support team. SFTS may induce an osmotic diarrhea because it contains sorbitol. A 55-year-old man admitted for a dissecting aneurysm was started on isotonic formula enteral feedings and within a day of starting SFTS developed severe diarrhea. The sorbitol-induced osmotic diarrhea persisted for 36 of his 83 days of hospitalization with direct cost for the evaluation of this diarrhea being $4,250. His prolonged hospitalization cost $166,200. A retrospective review of 20 consecutive patients receiving SFTS revealed that 15 patients had diarrhea for 2 or more consecutive days compared with 20 patients receiving iv aminophylline, of whom only two patients had diarrhea. Furthermore, SFTS was administered to healthy volunteers and a prominent breath hydrogen response was noted. The polyalcohol sorbitol is used as a sweetner in "sugar-free" products and not quantified on labeling because it is considered an inactive ingredient. Nutritionists should be aware that medicinal solutions can contain enough sorbitol to create a laxative effect which is an easily reversible cause of diarrhea in enterally fed patients. (Journal of Parenteral and Enteral Nutrition 15:332-336, 1991)

Journal of Parenteral and Enteral Nutrition, Vol. 15, No. 3, 332-336 (1991)
DOI: 10.1177/0148607191015003332


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