AUTHOR=Satoh Kasumi , Nakae Hajime 

TITLE=Daijokito Administration in Critically Ill Patients Increasing the Stool Volume: A Retrospective Observational Study

JOURNAL=Frontiers in Nutrition

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.749570

DOI=10.3389/fnut.2021.749570

ISSN=2296-861X

ABSTRACT=<p><bold>Introduction:</bold><italic>Daijokito</italic>, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of <italic>Daijokito</italic> has not been thoroughly investigated in critical care. To investigate a new Kampo approach to defecation control in critically ill patients, our study aimed to assess the effects of <italic>Daijokito</italic> on fecal management.</p><p><bold>Methods:</bold> We analyzed 30 consecutive patients treated with <italic>Daijokito</italic> in the intensive care unit (ICU) between March 2017 and February 2021. The eligibility criteria were patients who were newly prescribed <italic>Daijokito</italic> in the ICU during the study period. Exclusion criteria were patients who were started on other laxatives within one day of beginning <italic>Daijokito</italic>. The study's primary outcome was defecation volume three days before and three days after starting <italic>Daijokito</italic>. We recorded the most dominant stool quality within three days after the start of <italic>Daijokito</italic>.</p><p><bold>Results:</bold> Twenty-one patients were included in the analysis. The median age was 69.0 years, and the median sequential organ failure assessment score on admission to the ICU was 6.0. Major diseases included trauma, pancreatitis, and burns. Administration of <italic>Daijokito</italic> resulted in defecation in 17 of twenty-one patients (81.0%). Comparison of defecation volume between 3 days before <italic>Daijokito</italic> administration and three days, including the day of <italic>Daijokito</italic> administration, showed that defecation volume increased significantly after <italic>Daijokito</italic> administration, with a median of 0 to 360 g (<italic>p</italic> &lt; <italic>0.001</italic>). At the three-day follow-up, six of 17 (35.3%) patients defecated on the day of <italic>Daijokito</italic> administration, and nine (52.9%) defecated on the day after administration. One patient was judged to have excessive defecation, and <italic>Daijokito</italic> administration was discontinued. Stool quality was normal in one (5.9%) of the 17 patients, soft-formed in two (11.8%), loose-unformed in 11 (64.7%), and liquid in three (17.6%).</p><p><bold>Discussion:</bold><italic>Daijokito</italic> administration in critically ill patients caused defecation in 81% of the patients and significantly increased stool volume. The novelty of this study is that it sheds light on the Kampo treatment of defecation control in critically ill patients. In addition to the present report, further studies are warranted to quantify the therapeutic efficacy and safety of <italic>Daijokito</italic>.</p>