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The effects of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients
D Belknap1, L J Davidson, C R Smith
1University of Oklahoma College of Nursing, Oklahoma City 73190, USA. Dorothy-Belknap@uokhsc.edu
Insights
Psyllium hydrophilic mucilloid (PHM) did not significantly prevent diarrhea in enteral feeding patients. However, PHM administration may cause feeding tube obstruction, requiring careful monitoring and dilution.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Critical Care Medicine
Background:
- Enteral feeding is crucial for nutritional support but can lead to diarrhea.
- Preventing diarrhea in patients on enteral feeding is important for patient comfort and outcomes.
Purpose of the Study:
- To evaluate the effectiveness of psyllium hydrophilic mucilloid (PHM) in preventing diarrhea among patients receiving enteral feeding.
- To compare different methods of PHM administration.
Main Methods:
- A pilot study involving 60 patients initiated on enteral feeding via feeding tube.
- Patients received either PHM (7 gm twice daily) added to continuous feeding, PHM as a bolus with intermittent feeding, or no PHM for 7 days.
- Outcomes measured included diarrhea incidence, stool frequency/consistency, and feeding tube obstruction.
Main Results:
- No significant difference in diarrhea incidence between PHM and no-PHM groups.
- Patients receiving PHM in continuous feedings had more gelatinous stools.
- Combined PHM groups showed fewer liquid stools and more normal stools compared to the control group.
- 12% of patients receiving PHM experienced feeding tube occlusion.
Conclusions:
- This pilot study suggests PHM may alter stool consistency but did not significantly prevent diarrhea.
- Larger studies are needed to confirm these trends and PHM's efficacy.
- PHM administration carries a risk of feeding tube obstruction, necessitating adequate dilution and monitoring.
Objective:
To investigate the efficacy of psyllium hydrophilic mucilloid (PHM) for prevention of diarrhea and to compare methods of PHM delivery.
Design:
Experimental.
Setting:
University-affiliated Department of Veterans Affairs Medical Center.
Subjects:
Sixty patients from medical-surgical and intensive care units who received newly initiated enteral feeding via feeding tube.
Outcome Measures:
Diarrhea, stool frequency and consistency, and feeding tube obstruction.
Intervention:
Receipt of PHM (7 gm, twice-daily) added to continuous feeding or given as a bolus with intermittent feeding, or receipt of No PHM for 7 days after initiation of enteral feeding.
Results:
Fifteen subjects (25%) developed diarrhea (defined as 3 or more liquid stools per day, or 2 or more liquid stools on successive days). There were no significant differences in incidence of diarrhea or percentage of days of diarrhea between subjects who did and did not receive PHM. However, subjects who received PHM in their continuous feedings had a significantly higher number of gelatinous stools, and the combined PHM groups had a significantly lower number of liquid stools and a higher number of normal stools than did subjects who did not receive PHM. For the combined PHM groups, there was a 12% incidence of small-bore feeding tube occlusion--requiring replacement.
Conclusions:
Further study with a larger sample is necessary to evaluate trends found in this pilot study and to determine PHM efficacy for prevention of diarrhea. PHM administration may result in small-bore feeding tube obstruction, and thus requires adequate dilution and close monitoring.