Diarrhea associated with lorazepam solution in a tube-fed patient.
A 43-year-old patient with adult respiratory distress syndrome, alcoholic hallucinosis, and delirium required significant amounts of lorazepam, morphine, and midazolam for management of agitation and increased peak airway pressures. Broad-spectrum antibiotics and intermittent pancuronium therapy were instituted. A nasoenteral feeding tube was placed for nutrition and medication administration during mechanical ventilation. Tube feedings were well tolerated except for intermittent bouts of large amounts of diarrhea. Clostridium difficile culture and toxin results were negative. Lorazepam and morphine administration were converted from the IV to enteral route to decrease the amount of fluid administered. The tube feeding was changed to an electrolyte rehydration solution and eventually discontinued. A search for drug-related contributing factors to the diarrhea revealed polyethylene glycol present in the lorazepam solution. It was postulated that this could be a contributing cause to the diarrhea. The lorazepam solution was changed to enterally administered crushed tablets with subsequent resolution of diarrhea.
Shepherd
M F
MF
Felt-Gunderson
P A
PA
D000328:Adult; D003967:Diarrhea / Q000139:chemically induced*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008140:Lorazepam / Q000009:adverse effects*; D012996:Solutions
D006993:Hypnotics and Sedatives; D012996:Solutions; D008140:Lorazepam