The patient has just been started on an enteral feeding and has developed diarrhea after being on the feeding for 2 hours. The most likely cause of the diarrhea would be
a. Clostridium difficile.
b. Antibiotic therapy.
c. Formula intolerance.
d. Bacterial contamination.
ANS: C
Hyperosmolar formulas can cause diarrhea. If that is the case, the solution is to lower the rate, dilute the formula, or change to an isotonic formula. Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for Clostridium difficile toxin buildup. However, this takes time, and no indication suggests that this patient was on antibiotics. Proximity to the start of the enteral feedings is more suspicious. Bacterial contamination of the feeding usually occurs when feedings are left hanging for longer than 8 hours.
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