Most likely cause of watery diarrhea and bloating in the enterally fed adult patient?

• A. lactose content of enteral formula
• B. Soribitol content of liquid medications
• C. Soribitol content of the enteral formula
• D. Lactose content of liquid medications

Answer: (B)

Osmotic diarrhea driven by a poorly absorbed sugar alcohol, such as sorbitol, is the likely cause. Sorbitol is commonly used in liquid medications as a sweetener or excipient and isn’t fully absorbed in the small intestine. When these meds are given to a patient receiving enteral nutrition, the sorbitol reaches the colon, drawing water into the lumen and being fermented by gut bacteria. This leads to increased stool water content and gas production, causing watery diarrhea and bloating. Lactose in formulas or medications can cause symptoms in those with lactose intolerance, but sorbitol in liquid meds is the more common and more likely trigger in this context.