• Diarrhea might also have an adverse effect on

nutrition status as a fecal weight >350 mL/d is

associated with significant negative energy balance
(loss of 627 kcal/d vs neutral balance; P = .01).
Wierdsma NJ, Peters JH, Weijs PJ, et al. Malabsorption and nutritional balance in the ICU: fecal weight as a
biomarker: a prospective observational pilot study. Crit Care. 2011;15(6):R264.
 腹瀉的型式
型式 敘述 特徵 常見原因

蠕動異常型 胃、小腸或結腸運動改變， 腹瀉與便秘交替發生 大腸激躁症(IBS)

加速胃排空時間 間歇性腹痛 術後(胃切除術、迷走神經切斷術)

發炎滲出型 因腸道發炎，影響水和電 在糞便中有粘液、血液或 腸腔損傷(放射性腸炎)

解質的吸收 血漿蛋白質 小腸病
白血球數目增加
吸收不良型 因消化不良導致對營養素 腹脹 短腸症候群
的吸收不佳 脹氣 小腸細菌過度生長
脂肪瀉 胰腺功能不全
體重減輕 胃繞道手術

滲透壓型 腸腔內溶質過多無法吸收， 禁食可減少糞便體積 藥物(滲透性瀉藥)和制酸劑(鎂、

始滲透壓高於血漿滲透壓， (<1L/d) 磷酸鹽、硫酸鹽)
造成大量水分移出至腸腔 乳糖不耐症

分泌型 以超過腸道吸收能力的流 與食物攝取無關，禁食無 膽酸吸收不良

速及大量的流體進入腸腔 法減少糞便體積(>1L/d) 感染(大腸桿菌、困難梭狀桿菌、
沙門氏菌)
藥物(抗生素等)
• Understanding the type of diarrhea can help to
establish a diagnosis and guide treatment.
Clausen MR, Mortensen PB. Kinetic studies on colonocyte metabolism
of short chain fatty acids and glucose in ulcerative colitis. Gut.
1995;37(5):684-689.
評估腹瀉
• These definitions are based on criteria of frequency
(>2 stools, >3 stools, >4 stools), consistency
(unformed, liquid), weight (>200 g, >300 g),
duration (>1 day, >48 hours), and a combination of
frequency and consistency.
• 頻率
• 性狀
• 重量
• 持續時長
Bristol stool scale (BSS)

• Despite the chart’s reliability, its use might not be appropriate for
sick individuals, hospitalized, taking medications, and on ETF.
• Diarrhea is defined as bowel opening >3/d type 7 for ≥48 hours.
Whelan K, Judd PA, Taylor MA. Assessment of fecal output in patients
receiving enteral tube feeding: validation of a novel chart. Eur J Clin Nutr.
2004;58(7):1030-1037.
Medications
• Other medications, such as drugs containing sorbitol or
other carbohydrates as excipients, can also cause
diarrhea.
• Other medications known to cause diarrhea include
antihypertensives, cholinergics, glucose-lowering
agents, anti-inflammatory drugs, laxatives,
chemotherapy agents, and prokinetics.
• Prokinetics, commonly used in the ICU setting to
support feed absorption, have been associated with
diarrhea.
• Consequently, discontinuing or reducing the dose of an
offending medication or changing the form of the
medication can help reduce medication-induced
diarrhea.
本院使用之 Prokinetic Drugs
Fiber

A.S.P.E.N. guidelines, 2016

 調整/高蛋白
膳食醫令 調整均衡配方 纖維配方 高蛋白配方 糖尿配方 高脂肪配方 低蛋白配方 洗腎配方
/高脂配方
Osmolite Ensure
Osmolite COMPLEAT Jevity Glucerna S Pulmocare Suplena Nepro
品項 HN TwoCal
管灌安素 諾沛# 健力體 葡勝納嚴選 益肺佳 腎補納 普寧勝
愛美力 雙卡
Osmolarity 300 356 311 300 450 475 725 780 745

Concentration 1 kcal/mL 1 kcal/mL 1 kcal/mL 1 kcal/mL 1 kcal/mL 1.5 kcal/mL 2 kcal/mL 1.8 kcal/mL 1.8 kcal/mL

14% 18% 16.6% 16.7% 20% 16.7% 16.7% 10% 18%

Protein
-1.05 g/kg$ -1.35 g/kg$ -1.24 g/kg$ -1.25 g/kg$ -1.5 g/kg$ -1.25 g/kg$ -1.25 g/kg$ -0.75 g/kg$ -1.35 g/kg$

Carbohydrate 56.7% 48% 53.3% 31% 43.2% 42% 34%

54.3% 28.2%
-Fiber(g/1000kcal) -Fiber 5g -Fiber 13.2g -Fiber 14.4g -Fiber 2.5g -Fiber 7g -Fiber 7g

30.1%
29.3% 55.1% 40.1%
Fat 34% -MCT 29% 49% 48% 48%
-MCT 19.1% -MCT 20% -MCT 19.2%
19.1%

Na 633 Na 1038 Na 869 Na 880 Na 940 Na 873 Na 726 Na 447 Na 588

Electrolyte K 952 K 2035 K 1311 K 1480 K 1300 K 1310 K 1221 K 635 K 588
(mg/1000kcal) Ca 502 Ca 890 Ca 869 Ca 720 Ca 700 Ca 704 Ca 526 Ca 588 Ca 588
P 502 P 1018 P 717 P 720 P 652 P 704 P 526 P 400 P 400

Pictures

#: 指protal畫面無此選項，需另自行備註；$: 指灌食總熱量設定在30kcal/kg時蛋白質供應量

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 膳食醫令 成人元素配方
Nu-Immu (P) Nu-Pep (P) Vivonex (P) Alitraq (P) Peptamen (P) Twinline (L)
品項
勉益增 新普派 非凡寧適 創快復 佳易得 雙備素
Osmolarity
430 395 650 575 350 590
(1 kcal/mL)
18%
22% 20% (16+5)% 16%
-100% amino
-100% whey -100% -Hydrolyzed soy 16% -Peptide+amino
acid
Protein protein hydrolyzed whey
-Gln + Arg
protein + whey -100% whey acid
-Gln + Arg protein -Gln + Arg -1.2 g/kg$ -Gln + Arg
+BCAA
-1.65 g/kg$ -1.5 g/kg$ -1.2(1.6)* g/kg$ -1.2 g/kg$
-1.35 g/kg$

Carbohydrate 53% 65% 76% 65.7% 49% 59%

25% 15% 13.2% 35% 25%
Fat 6%
-MCT 46% -MCT 50% -MCT 53% -MCT 70% -MCT 70%
Na 746 Na 1038 Na 610 Na 1000 Na 803 Na 690
Electrolyte K 1045 K 1081 K 1060 K 1200 K 1276 K 1175
(mg/1000kcal) Ca 920 Ca 675.2 Ca 560 Ca 733 Ca 814 Ca 440
P 597 P 675.2 P 560 P 733 P 715 P 530

Pictures

#: 指protal畫面無此選項，需另自行備註；$: 指灌食總熱量設定在30kcal/kg時蛋白質供應量

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