The effects of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients

OBJECTIVE: To investigate the efficacy of psyllium hydrophilic mucilloid (PHM) for prevention of diarrhea and to compare methods of PHM delivery. DESIGN: Experimental. SETTING: University-affiliated Department of Veterans Affairs Medical Center. SUBJECTS: Sixty patients from medical-surgical and intensive care units who received newly initiated enteral feeding via feeding tube. OUTCOME MEASURES: Diarrhea, stool frequency and consistency, and feeding tube obstruction. INTERVENTION: Receipt of PHM (7 gm, twice-daily) added to continuous feeding or given as a bolus with intermittent feeding, or receipt of No :PHM for 7 days after initiation of enteral feeding. RESULTS: Fifteen subjects (25%) developed diarrhea (defined as 3 or more liquid stools per day, or 2 or more liquid stools on successive days). There were no significant differences in incidence of diarrhea or percentage of days of diarrhea between subjects who did and did not receive PHM. However, subjects who received PHM in their continuous feedings had a significantly higher number of gelatinous stools, and the combined PHM groups had a significantly lower number of liquid stools and a higher number of normal stools than did subjects who did not receive PHM. For the combined PHM groups, there was a 12% incidence of small-bore feeding tube occlusion-requiring replacement. CONCLUSIONS: Further study with a larger sample is necessary to evaluate trends found in this pilot study and to determine PHM efficacy for prevention of diarrhea. PHM administration may result in small-bore feeding tube obstruction, and thus requires adequate dilution and close monitoring.