title: PEG and Thickeners: A Critical Interaction Between Polyethylene Glycol Laxative and Starch-Based Thickeners.
abstract: Clinicians commonly encounter dysphagia and constipation in a skilled nursing population. Increasing the viscosity of liquids, usually with a starch- or xanthan gum-based thickener, serves as a key intervention for patients with dysphagia. We report a newly identified and potentially dangerous interaction between polyethylene glycol 3350 laxative (PEG) and starch-thickened liquids. A patient requiring nectar-thickened liquids became constipated, and medical staff prescribed PEG for constipation. His nurse observed that the thickened apple juice immediately thinned to near-water consistency when PEG was added. She obtained the same results with thickened water and coffee. We quantified this phenomenon by isothermal rotational rheology. Results confirmed a precipitous loss of thickening when PEG was added to starch-based thickeners but not with xanthan gum-based thickeners. Clinicians and front-line staff should be aware of this potentially critical interaction between PEG- and starch-based thickeners. Although confirmatory studies are needed, our preliminary data suggest that PEG may be compatible with xanthan gum-- based thickeners.
authors: University of South Florida College of Medicine, Tampa, FL. Electronic address: brianjcarlisle@gmail.com.
authors: Brian J
authors: BJ
authors: Carlisle
authors: University of South Florida College of Arts and Sciences, Tampa, FL.
authors: Garrett
authors: G
authors: Craft
authors: University of South Florida College of Arts and Sciences, Tampa, FL.
authors: Julie P
authors: JP
authors: Harmon
authors: James A. Haley VA Hospital, Tampa, FL.
authors: Alina
authors: A
authors: Ilkevitch
authors: James A. Haley VA Hospital, Tampa, FL.
authors: Jenik
authors: J
authors: Nicoghosian
authors: University of South Florida College of Medicine, Tampa, FL; James A. Haley VA Hospital, Tampa, FL.
authors: Inna
authors: I
authors: Sheyner
authors: University of South Florida College of Medicine, Tampa, FL; James A. Haley VA Hospital, Tampa, FL.
authors: Jonathan T
authors: JT
authors: Stewart
mesh_terms: D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000188:drug therapy*; D004347:Drug Interactions; D006801:Humans; D054368:Laxatives / Q000009:adverse effects*; D008297:Male; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage; D012866:Skilled Nursing Facilities; D013213:Starch; D014783:Viscosity / Q000187:drug effects*
chemical_list: D054368:Laxatives; D011135:Polysaccharides, Bacterial; D011092:Polyethylene Glycols; D013213:Starch; C002563:xanthan gum
keywords: Dysphagia; aspiration; laxatives; polyethylene glycol; thickeners