Skip to main content

GeriPal Taste Test Part I: Liquid Bowel Medications



GeriPal has put together a taste test on "Liquid Bowel Medications" (see attached video) which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!) docusate.

The conclusions are pretty clear. First, one should never give liquid docusate (colace) by mouth. Second, one should never, never, never ever crush docusate and mix it with applesauce.

This really begs the question whether colace should be prescribed in the hospice setting or in frail elderly patients, as both groups are at risk for losing their ability to swallow large pills. There is also very little evidence that docusate works. In a 2008 nonrandomized cohort study done in hospitalized patients with cancer, a senna only protocol was more effective than a senna+colace protocol. Even though this study was small, with only 30 patients in each group, it should make us question the continued use of this medication.

* to view a higher quality video on youtube click here.

by: Eric Widera (@ewidera)

Comments

Chrissy Kistler said…
I LOVED this! Everyone should see this. The one thing I wondered is the whole smell thing... Does Lactulose really smell bad, b/c I can imagine that would be a reason to give sorbitol over lactulose, especially for patients who seem to have hyperosmia. So, from the taste test it seems like sorbitol is the winner... Oh, and I also want to see how polyethylene glycol (aka miralax) stacks up, smell and taste wise... Oh and it was nice for you to talk about consistency, though it seemed like sorbitol and lactulose both have similar consistency? (Loved the comment about the legs on lactulose. ;) All in all, Oscar material!
Kitt said…
That was very cleverly done...
and thanks for getting this message out really loud and clear on FB too!
I enjoyed this(while I hated my colace testing on Palliative care in the last January!)
Namita Kansal said…
That was very cleverly done...
and thanks for getting this message out really loud and clear on FB too!
I enjoyed this(while I hated my colace testing on Palliative care in the last January!)
Eric Widera said…
The worst thing about lactulose was the deep green coloration and a very sweet aroma. The consistency is very much like a syrup, so much so that I heard that one patient only would take it if he could poor it over his pancakes (it wouldn't be bad for this purpose). Sorbitol is less of a syrup but still sweet.
IC Lohf said…
Haha! This was great! Next you should try the dietary supplements, like Ensure and Boost. Would love to see your reactions!
Patrice Villars said…
Very sophisticated and well controlled reactions to tasting the docusate. Was that because you were being videoed? Because when our patients with dementia are fed this stuff, they push it back out and "refuse" to eat. If we keep putting it in their mouths, often with other tasteful crushed meds, they stop taking anything from the nurses and often start to push away the food. Bad people with dementia. Bad "combative" people with dementia. Must be a personality trait. Could be disease related. Maybe we should give them neuroleptics..... Sigh.
Gary said…
Strong work doctors. Stuff is nasty. All housestaff should be made to taste docusate before prescribing!

(PEG-3350 is not too bad, pretty neutral overall.)
Anne Johnson said…
Well done! Great way to illustrate an important point.
Anonymous said…
Don't forget to try potassium liquid of potassium powder mix..yuck!!

Nelly
ken covinsky said…
Patrice---I think your point about patients with dementia is really important. In these patients, liquid docusate (colace) could have serious adverse consequences. It is very easy to see how the situation you describe would happen, where the patient will get agitated anytime a provider comes to them with a medicine or food, in fear that they will be fed some foul conconction.

There is really no good reason to give a patient liquid colace. Just don't do it. Get this medicine off your hospital, hospice, and nursing home formularies.
LeighSW said…
Better you than me- great work!
Jerry said…
I'm sticking with Ex-Lax.

Ummmm, chocolatey....
Anonymous said…
Ooh dang i just typed a big comment and as soon as i hit post it come up blank! Please please tell me it worked properly? I dont want to write it again if i do not have to! Either the blog glitced out or i am an idiot, the latter doesnt surprise me lol. Cheers, denver asbestos attorneys
Anonymous said…
Amiable fill someone in on and this fill someone in on helped me alot in my college assignement. Thank you for your information.
Anonymous said…
Hey, just want to say hi. I'm new here.

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  


You can also find us on Youtube!


Listen to GeriPal Podcasts on:
iTunes…

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…