Diarrhea associated with severe hypoalbuminemia: a comparison of a peptide-based chemically defined diet and standard enteral alimentation
Brinson, R.R.; Kolts, B.E.
Critical Care Medicine 16(2): 130-136
1988
ISSN/ISBN: 0090-3493 PMID: 3125004 Document Number: 317145
To demonstrate a relation between diarrhoeal incidence and the onset of hypoalbuminaemia developing as a result of acute protein-energy malnutrition and severe catabolism, 2 patients who had developed severe hypoalbuminaemia less than 2.5 g/100 ml and diarrhoea on a variety of enteral diets were studied. Each patient was placed on a peptide enteral formula at a rate of infusion equivalent to that used during the previous 24 h. Diarrhoeal volumes decreased significantly from more than 1500 to less than 100 and from more than 4000 to 800 ml daily. Subsequently 12 patients were studied in a randomized, prospective fashion to confirm previous observations. Seven patients were given a peptide enteral formula and 5 a standard isotonic enteral formula as control. The patients were monitored for a minimum of 2 weeks or until serum albumin reached 3 g/100 ml. Nutritional variables were estimated initially and every 4 days for the duration of the study. Of the patients receiving the isotonic feeding, only 1 of 5 completed the study period without diarrhoea. Two patients died of causes unrelated to the feeding and 3 patients developed severe diarrhoea within 48 h of the start of the study. Of the 7 patients receiving the peptide feeding, 6 completed the study period without diarrhoea. One patient had a large stool volume initially which decreased by day 2 of the study. It is concluded that a peptide enteral formula is well tolerated in patients with severe hypoalbuminaemia when compared with a standard isotonic enteral formula. The ability to provide enteral nutrition in a form that is well tolerated in hypoalbuminaemia patients may obviate the need for parenteral nutrition routinely in these patients.