Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/72327
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Type: Journal article
Title: Randomized double-blind crossover study to determine the effects of erythromycin on small intestinal nutrient absorption and transit in the critically ill
Author: Deane, A.
Wong, G.
Horowitz, M.
Zaknic, A.
Summers, M.
Di Bartolomeo, A.
Sim, J.
Maddox, A.
Bellon, M.
Rayner, C.
Chapman, M.
Fraser, R.
Citation: American Journal of Clinical Nutrition, 2012; 95(6):1396-1402
Publisher: Amer Soc Clinical Nutrition
Issue Date: 2012
ISSN: 0002-9165
1938-3207
Statement of
Responsibility: 
Adam M. Deane, Gerald L. Wong, Michael Horowitz, Antony V. Zaknic, Matthew J. Summers, Anna E. Di Bartolomeo, Jennifer A. Sim, Anne F. Maddox, Max S. Bellon, Christopher K. Rayner, Marianne J. Chapman and Robert J.L. Fraser
Abstract: BACKGROUND: The gastrokinetic drug erythromycin is commonly administered to critically ill patients during intragastric feeding to augment small intestinal nutrient delivery. However, erythromycin has been reported to increase the prevalence of diarrhea, which may reflect reduced absorption and/or accelerated small intestinal transit. OBJECTIVE: The objective was to evaluate the effects of intravenous erythromycin on small intestinal nutrient absorption and transit in the critically ill. DESIGN: On consecutive days, erythromycin (200 mg in 20 mL 0.9% saline) or placebo (20 mL 0.9% saline) were infused intravenously between 220 and 0 min in a randomized, blinded, crossover fashion. Between 0 and 30 min, a liquid nutrient containing 3-Omethylglucose (3-OMG), [13C]triolein, and [99mTc]sulfur colloid was administered directly into the small intestine at 2 kcal/min. Serum 3-OMG concentrations and exhaled 13CO2 (indices of glucose and lipid absorption, respectively) were measured. Cecal arrival of the infused nutrient was determined by scintigraphy. Data are medians (ranges) and were analyzed by using Wilcoxon’s signed-rank test. RESULTS: Thirty-two mechanically ventilated patients were studied. Erythromycin increased small intestinal glucose absorption [3-OMG AUC360: 105.2 (28.9–157.0) for erythromycin compared with 91.8 (51.4–147.9) mmol/L _ min for placebo; P = 0.029] but tended to reduce lipid absorption [cumulative percentage dose 13CO2 recovered: 10.4 (0–90.6) compared with 22.6 (0–100) %; P = 0.06]. A trend to slower transit was observed after erythromycin [300 (39– 360) compared with 228 (33–360) min; P = 0.07]. CONCLUSIONS: Acute administration of erythromycin increases small intestinal glucose absorption in the critically ill, but there was a tendency for the drug to reduce small intestinal lipid absorption and slow transit. These observations have implications for the use of erythromycin as a gastrokinetic drug in the critically ill. This trial was registered in the Australian New Zealand Clinical Trials Registry as ACTRN 12610000615088.
Keywords: Cecum; Intestine, Small; Humans; Nutrition Disorders; Critical Illness; Diarrhea; Carbon Dioxide; Sulfur; Erythromycin; Glucose; Gastrointestinal Agents; Gastrointestinal Transit; Respiration, Artificial; Enteral Nutrition; Infusions, Intravenous; Cross-Over Studies; Double-Blind Method; Intestinal Absorption; Adult; Aged; Middle Aged; Female; Male; Carbohydrate Metabolism; Lipid Metabolism; Young Adult
Rights: © 2012 American Society for Nutrition
RMID: 0020119289
DOI: 10.3945/ajcn.112.035691
Appears in Collections:Medicine publications

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