Olivia S1, Bee Xian A2, Ying Ting E1, Lina I2
1Department of Dietetics, Faculty of Medicine and Health Sciences, UPM
2Department of Dietetics, Hospital Melaka
Diarrhea is a common problem among enterally fed patients which will affect recovery and prolong hospital stay. Medications, bacterial contamination or infection, underlying disease, and the mode of feeding itself are several factors that contribute to diarrhea among patients.
Mr. GK is a 57 years old Indian male presented with right hemiparesis and expressive aphasia with bulbar involvement post MCA Infarct and AKI. Patient has underlying DM, Dyslipidemia and IHD. Estimated height is 1.75m, dosing weight given at estimated IBW at BMI 22.5 (69kg). Ryle’s tube was inserted after admission and feeding was started with diabetic specific formula. However, patient started to have frequent loose and watery stool (Bristol 6-7) and his blood glucose (GM) had deranged. Insulin therapy was initiated.
Inadequate enteral nutrition infusion related to infusion volume not reached due to diarrhea and high GM as evidenced by food history.
Management aimed to improve diarrhea and to control GM while ensuring adequate energy and protein to prevent complications. Nutrition prescription was given at 25-30kcal/kg (1725-2070kcal) with 1.0-1.2g/kg (68-82g) protein. Modular fiber containing 100% soluble fiber was given as first line of treatment to solve patient’s diarrhea while possible medication which may cause diarrhea were ruled out by Doctor. Diarrhea was not resolved after 4 days and feeding was changed to fiber specific formula (50% soluble and 50% insoluble). Afterwards, diarrhea resolved but GM spikes up to 30mmol/L, may be related to sucrose and maltodextrin content. Feeding was then changed to another formula which is suitable for diabetes (GI=28) containing 30% soluble and 70% insoluble fiber.
Monitoring & Evaluation
Diarrhea and GM were well controlled by Day 18. Patient was discharged on Day 23 with 7.5 scoops + 350cc H2O, 4hourly, 5x/day (96% energy adequacy and 1.09g/kg protein) after completing antibiotic treatment.