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ICU GUIDELINE: MANAGEMENT OF DIARRHEA

ICU GUIDELINE: MANAGEMENT OF DIARRHEA . www.criticalcarenutrition.com. START. Stool output >3 - 5 liquid BM or > 750 mL over 24 h?. No. No Intervention. Yes. Medical/surgical hx consistent with diarrhea? (see purple BOX - A). Risk of stool impaction? (see blue BOX - B).

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ICU GUIDELINE: MANAGEMENT OF DIARRHEA

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  1. ICU GUIDELINE: MANAGEMENT OF DIARRHEA www.criticalcarenutrition.com START Stool output >3 - 5 liquid BM or > 750 mL over 24 h? No No Intervention. Yes Medical/surgical hx consistent with diarrhea? (see purple BOX - A) Risk of stool impaction? (see blue BOX - B) Receiving cathartic agents? (see orange BOX - C) No No No No Distended, tympanic, or painful abdomen? Yes Yes Yes Yes Discontinue EN. MD to review patient. Medical intervention as indicated. Rectal check; manual disimpaction if positive. Obtain abdominal x-ray to rule out more proximal impaction as indicated. Change all oral liquid medications to tablet or parenteral alternative; change oral electrolyte solutions to parenteral route; discontinue all known cathartics (seeBOX - C) if possible. Pharmacist to review to rule out other potential drug related cause of diarrhea. A: IBD, terminal ileal resection, chemotherapy, short bowel, pancreatic insufficiency, etc. B: Chronic constipation, absent BM x 5 days, regular narcotic use, limited fluid intake. C: Citromag®, docusate, Milk of Magnesia® ,cascara, enema, PEG, hypertonic or sorbitol- containing liquid medications, oral electrolyte solutions, lactulose, Kayexalate®, etc. Rule out C. difficile associated diarrhea, bowel ischemia, other.If all investigations negative, consider fiber- containing formulae. Initiate antidiarrhea agent. Reassess need/dose daily. No Diarrhea resolved? Developed by J. Greenwood, RD. Critical Care Program - Vancouver Coastal Health Authority. Modified for use by CCN (7/4/2010)

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