Chapter 073. Enteral and Parenteral Nutrition (Part 13) Diarrhea Enteral feeding often leads to diarrhea, especially if bowel function is compromised by disease or drugs, particularly broad-spectrum antibiotics. Diarrhea may be controlled by the use of a continuous drip, with a fiber-containing formula, or by adding an antidiarrheal agent to the formula. However, Clostridium difficile, which is a common cause of diarrhea in patients being tube fed, should be ruled out before using antidiarrheal agents. H2 blockers may also assist in reducing the net fluid presented to the colon. Diarrhea associated with enteral feeding does not necessarily imply inadequate absorption of nutrients other than water and electrolytes. Amino acids and glucose are particularly well absorbed in the upper small bowel except in the most diseased or shortest bowel. Since luminal nutrients exert trophic effects on the gut mucosa, it is often appropriate to persist with tube feeding, despite the diarrhea, even when this necessitates supplemental parenteral fluid support. Acknowledgment The authors acknowledge the contributions of Lyn Howard, MD, the author in earlier editions of HPIM, to material in this chapter Further Readings August D et al: Evidence-based approach to optimal manag ement of HPEN access. J Parenter Enteral Nutr 30:S5, 2006 Bistrian B, McCowen K: Nutritional support in the adult intensive care unit: Key controversies. Crit Care Med 34:1525, 2006 [PMID: 16557154] Centers for Disease Control and Prevention: Reduction in central line– associated bloodstream infections among patients in intensive care units— Pennsylvania, April 2001–March 2005. MMWR 54:1013, 2005 Debaveye Y, Van den Berghe G: Risks and benefits of nutritional support during critical illness. Annu Rev Nutr 26:513, 2006 [PMID: 16848718] Koretz RL et al: Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol 102(2):412, 2007 [PMID: 17311654] Milne A et al: Meta-analysis: Protein and energy supple mentation in older people. Ann Intern Med 144:37, 2006 [PMID: 16389253] Plank LD, Hill GL: Energy balance in critical illness. Proc Nutr Soc 62:545, 2003 [PMID: 14506903] Simpson F, Doig GS: Parenteral vs. enteral nutrition in the critically ill patient: A meta- analysis of trials using the intention to treat principle. Intensive Care Med 31:12, 2005 [PMID: 15592814] van den Berghe G et al: Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359, 2001 . Chapter 073. Enteral and Parenteral Nutrition (Part 13) Diarrhea Enteral feeding often leads to diarrhea, especially if bowel. Y, Van den Berghe G: Risks and benefits of nutritional support during critical illness. Annu Rev Nutr 26:513, 2006 [PMID: 16848718] Koretz RL et al: Does enteral nutrition affect clinical outcome?. critical illness. Proc Nutr Soc 62:545, 2003 [PMID: 14506903] Simpson F, Doig GS: Parenteral vs. enteral nutrition in the critically ill patient: A meta- analysis of trials using the intention