Journal of the American College of Nutrition, Vol 6, Issue 6 517-523, Copyright © 1987 by American College of Nutrition

JOURNAL ARTICLE

Diarrhea in the intensive care unit: the role of hypoalbuminemia and the response to a chemically defined diet (case reports and review of the literature)

R. R. Brinson, W. D. Curtis and M. Singh
Department of Internal Medicine, Medical College of Georgia, Augusta 30912.

We describe five patients who developed acute kwashiorkor-like hypoalbuminemia during their hospitalization in the intensive care unit. With the initiation of enteral alimentation, diarrhea ensued and continued for at least 48 hours. Routine evaluation for the cause of diarrhea including stool culture for enteric pathogens, white blood cells, ova and parasites, Clostridium difficile cytotoxin, and flexible sigmoidoscopy was negative. When a peptide based formula (Vital HN, Ross Laboratories, Columbus, OH) was initiated, there was a significant reduction in stool output within 24 hours. In three of the five cases, hypoalbuminemia corrected within 2 weeks. Four of the five patients were discharged from the hospital. Although several reports have acknowledged the association between hypoalbuminemia and impaired gastrointestinal absorption, no previous enteral formula has been tolerated in these acutely ill patients until serum albumin levels had improved. Further studies will be required to confirm the better gastrointestinal tolerance of this peptide based formula in patients with severe hypoalbuminemia.

This article has been cited by other articles:

				R. L. Koretz Intravenous Albumin and Nutrition Support: Going for the Quick Fix JPEN J Parenter Enteral Nutr, March 1, 1995; 19(2): 166 - 171. [Abstract] [PDF]

				J. P. Doweiko and D. J. Nompleggi Reviews: The Role of Albumin in Human Physiology and Pathophysiology, Part III: Albumin and Disease States JPEN J Parenter Enteral Nutr, July 1, 1991; 15(4): 476 - 483. [PDF]

				R. R. Brinson Invited Review: The Effect of Peptide-Based Diets On the Intestinal Microcirculation in a Rat Model Nutr Clin Pract, December 1, 1990; 5(6): 238 - 240. [PDF]

				C. Viall, K. Porcelli, J. C. Teran, R. N. Varma, and W. P. Steffee A Double-Blind Clinical Trial Comparing the Gastrointestinal Side Effects of Two Enteral Feeding Formulas JPEN J Parenter Enteral Nutr, May 1, 1990; 14(3): 265 - 269. [Abstract] [PDF]

				R. R. Brinson and W. M. Pitts Diarrhea and the Burn Patient: Is Lipid in Enteral Formulas Really Deleterious? JPEN J Parenter Enteral Nutr, March 1, 1989; 13(2): 221 - 222. [PDF]

				M. M. Cottschlich and J. W. Alexander Response to Letter from Drs Brinson and Pitts JPEN J Parenter Enteral Nutr, March 1, 1989; 13(2): 222 - 222. [PDF]

				R. P. Bynoe, K. A. Kudsk, T. C. Fabian, and R. O. Brown Invited Review: Nutrition Support in Trauma Patients Nutr Clin Pract, August 1, 1988; 3(4): 137 - 144. [PDF]