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Related Experiment Videos

Nosocomial diarrhea: beware the medicinal elixir.

T E Edes1, B E Walk

  • 1Department of Medicine, Harry S. Truman Memorial Veterans Hospital, Columbia, MO.

Southern Medical Journal
|December 1, 1989
PubMed
Summary

Hospital-acquired osmotic diarrhea was linked to theophylline elixir, not theophylline itself. Patients experienced relief when switched to other forms, revealing sorbitol in elixirs as the cause.

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Area of Science:

  • Gastroenterology
  • Clinical Pharmacy
  • Hospital Epidemiology

Background:

  • Theophylline is a common medication for respiratory conditions.
  • Diarrhea is a frequent complication in hospitalized patients.
  • Osmotic diarrhea is typically caused by malabsorbed substances.

Observation:

  • A persistent case of osmotic diarrhea unresponsive to fasting was investigated.
  • Multiple patients developed diarrhea after starting theophylline elixir.
  • Diarrhea characteristics suggested an osmotic cause, inconsistent with theophylline's known secretory effects.

Findings:

  • Theophylline elixir contained high amounts of sorbitol, a laxative agent.
  • Patients receiving the elixir experienced osmotic diarrhea exceeding 1000 ml/24 hr.
  • Switching to intravenous or solid oral theophylline resolved diarrhea within 24 hours.

Implications:

  • Medicinal elixirs, even "sugar-free" ones, can contain sorbitol.
  • Sorbitol in elixirs is an unrecognized cause of hospital-acquired osmotic diarrhea.
  • Clinicians should consider elixir formulations when diagnosing persistent diarrhea in inpatients.

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