When treating diarrhea in enterally fed patients, which change is recommended after ruling out infectious causes?

• A. Change to isotonic formula or a fiber-containing formula
• B. Increase fat content of the formula
• C. Decrease water content of the formula
• D. Continue the current formula without changes

Answer: (A)

When infection has been ruled out, diarrhea in people receiving enteral nutrition is often helped by adjusting the formula to reduce the intestinal osmotic load and by adding soluble fiber. An isotonic formula has osmolality close to that of plasma, which lowers the amount of water drawn into the gut lumen and can lessen osmotic diarrhea from poorly absorbed or hyperosmolar feeds. A fiber-containing formula supplies soluble fiber that absorbs water, forms a gel, and slows intestinal transit, improving stool form and reducing liquidity and frequency. Increasing fat content could worsen diarrhea by promoting malabsorption or steatorrhea, decreasing water content would concentrate the formula and may worsen symptoms, and continuing the current formula ignores a modifiable cause.