Wednesday January 10, 2007
Stool Osmolal Gap !


About one third of patients on enteral feeding develops diarrhea in ICU. One easy way to confirm diarrhea secondary to enteral feed is to calculate Stool Osmolal Gap. The formula of Stool Osmolal Gap is

Stool Osmolal Gap = Measured stool osmolality - 2 (stool Na - stool K)

A stool Osmolal Gap more than 160 mOsm/kg H2O is most probably related to enteral feed in ICU or may be due to medications. Other causes of higher stool osmolal gap are pancreatic insufficiency, celiac sprue, lactose intolerance etc. but they are relatively uncommon.


Note: In ICU if stool osmolal gap is less than 50 mOsm/kg H2O, secretory diarrhea from C.diff. colitis should be ruled out as a first thing.

Tuesday January 9, 2007
One old lesson !!


To intubate or not to intubate?

Intubate !


One important lesson learned over years in Critical Care Medicine and endorsed by gurus is to intubate when ever there is a question of it. This lesson is far more important today in ICUs in view of increase use of "BiPAP" where there is a tendency to over-delay intubations in the hope of avoiding it. If BiPAP is not giving results quicky - Intubate !!




Reference:

Indications for mechanical ventilation - Paul L Marino - The ICU BooK - 3rd edition - Page 461