October 2015 Quiz 2

ANSWER: C

Critique

The first step in managing this patient should not be to stop the tube feedings. Enteral feedings are providing much-needed nutrition to this patient. There is no evidence that either continuous or bolus feedings are superior. Diarrhea has been shown to occur in up to 18% of patients receiving enteral nutrition. Clostridium difficile is the leading cause of health care–associated diarrhea. Antibiotic therapy is the most common risk factor associated with acquisition of C. difficile infection. Internally fed patients are more likely than non–tube fed patients to acquire C. difficile infection and, therefore, it is recommended to check for C. difficile in tube-fed patients, especially when they are receiving antibiotics. The patient has no comorbid conditions that would require elemental formula, such as short bowel syndrome or malabsorption. In addition, it is not clear that elemental formulas are superior to standard formulas in patients with malabsorption or maldigestion. Finally, standard polymeric formulas are lactose free. Other considerations in a patient on enteral feedings with diarrhea include non–C. difficile antibiotic-associated diarrhea, formula composition, sorbitol-containing medication preparations, and side effects of medications as well as hypoalbuminemia.

References

1. Loo V.G., Bourgault A.M., Poirier L., et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693-703.

2. Bliss D.Z., Johnson S., Savik K. Acquisition of Clostridium difficile and Clostridium difficile–associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med. 1998;129:1012.

3. Macleod J.B., Lefton J., Houghton D., et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma. 2007;63:57.

ANSWER: C

Critique

The first step in managing this patient should not be to stop the tube feedings. Enteral feedings are providing much-needed nutrition to this patient. There is no evidence that either continuous or bolus feedings are superior. Diarrhea has been shown to occur in up to 18% of patients receiving enteral nutrition. Clostridium difficile is the leading cause of health care–associated diarrhea. Antibiotic therapy is the most common risk factor associated with acquisition of C. difficile infection. Internally fed patients are more likely than non–tube fed patients to acquire C. difficile infection and, therefore, it is recommended to check for C. difficile in tube-fed patients, especially when they are receiving antibiotics. The patient has no comorbid conditions that would require elemental formula, such as short bowel syndrome or malabsorption. In addition, it is not clear that elemental formulas are superior to standard formulas in patients with malabsorption or maldigestion. Finally, standard polymeric formulas are lactose free. Other considerations in a patient on enteral feedings with diarrhea include non–C. difficile antibiotic-associated diarrhea, formula composition, sorbitol-containing medication preparations, and side effects of medications as well as hypoalbuminemia.

References

1. Loo V.G., Bourgault A.M., Poirier L., et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693-703.

2. Bliss D.Z., Johnson S., Savik K. Acquisition of Clostridium difficile and Clostridium difficile–associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med. 1998;129:1012.

3. Macleod J.B., Lefton J., Houghton D., et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma. 2007;63:57.

ANSWER: C

Critique

The first step in managing this patient should not be to stop the tube feedings. Enteral feedings are providing much-needed nutrition to this patient. There is no evidence that either continuous or bolus feedings are superior. Diarrhea has been shown to occur in up to 18% of patients receiving enteral nutrition. Clostridium difficile is the leading cause of health care–associated diarrhea. Antibiotic therapy is the most common risk factor associated with acquisition of C. difficile infection. Internally fed patients are more likely than non–tube fed patients to acquire C. difficile infection and, therefore, it is recommended to check for C. difficile in tube-fed patients, especially when they are receiving antibiotics. The patient has no comorbid conditions that would require elemental formula, such as short bowel syndrome or malabsorption. In addition, it is not clear that elemental formulas are superior to standard formulas in patients with malabsorption or maldigestion. Finally, standard polymeric formulas are lactose free. Other considerations in a patient on enteral feedings with diarrhea include non–C. difficile antibiotic-associated diarrhea, formula composition, sorbitol-containing medication preparations, and side effects of medications as well as hypoalbuminemia.

References

1. Loo V.G., Bourgault A.M., Poirier L., et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693-703.

2. Bliss D.Z., Johnson S., Savik K. Acquisition of Clostridium difficile and Clostridium difficile–associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med. 1998;129:1012.

3. Macleod J.B., Lefton J., Houghton D., et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma. 2007;63:57.