Food Dye Use in Enteral Feedings: A Review and a Call for a Moratorium

Nutrition in Clinical Practice

Volumn 17, Issue 3, 2002, Pages 169-181

  Maloney, James P ^a   Ryan, Tracey A ^b   Brasel, Karen J ^a   Binion, David G ^a   Johnson, Deborah R ^c   Halbower, Ann C ^d   Frankel, Eric H ^e   Nyffeler, Michael ^c   Moss, Marc ^f  

^a MEDICAL COLLEGE OF WISCONSIN   (United States)

^b FROEDTERT MEMORIAL LUTHERAN HOSPITAL   (United States)

^c MERITER HOSPITAL   (United States)

^d JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e Texas Tech University Health Sciences Center   (United States)

^f EMORY UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84992892956     PISSN: 08845336     EISSN: 19412452     Source Type: Journal    
DOI: 10.1177/0115426502017003169     Document Type: Review

References (102)

1. Huxley EJ, Viroslav J, Gray WR, et al. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 64:564-568, 1978
2. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: The effect of body position. Ann Intern Med 116:540-543, 1992
3. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group Am J Respir Crit Care Med 159:1249-1256, 1999
4. Heyland DK, Tougas G, King D, et al. Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 22:1339-1344, 1996
5. Heyland DK, Drover JW, MacDonald S, et al. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial. Crit Care Med 29:1495-1501, 2001
6. Taylor TT. A comparison of two methods of nasogastric tube feedings. J Neurosurg Nurs 14:49-55, 1982
7. Mullan H, Roubenoff RA, Roubenoff R. Risk of pulmonary aspiration among patients receiving enteral nutrition support. JPEN 16:160-164, 1992
8. Treloar DM, Stechmiller J. Pulmonary aspiration in tube-fed patients with artificial airways. Heart Lung 13:667-671, 1984
9. Sills MR, Zinkham WH. Methylene blue-induced Heinz body hemolytic anemia. Arch Pediatr Adolesc Med 148:306-310, 1994
10. www.foodsafety.gov, Accessed: January, 2002
11. Potts RG, Zarovkian MH, Guerrero PA, et al. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults. Chest 103:117-121, 1993
12. File TM Jr, Tan JS, Thomson RB Jr, et al. An outbreak of Pseudomonas aeruginosa ventilator-associated respiratory infections due to contaminated food coloring dye-further evidence of the significance of gastric colonization preceding nosocomial pneumonia. Infect Control Hosp Epidemiol 16:417-418, 1995
13. Curtas S, Forbes B, Meguid V, et al. Bacteriological safety of closed enteral nutrition delivery system. Nutrition 7:340-343, 1991
14. Metheny NA, Aud MA, Wunderlich RJ. A survey of bedside methods used to detect pulmonary aspiration of enteral formula in intubated tube-fed patients. Am J Crit Care 8:160-167, 1999
15. Ryan TA, Batchelder SL, Maloney JP. FD&C Blue No. 1 food dye absorption from enteral tube feedings in sepsis: A summary of five cases (four deaths) linked to systemic absorption. J Am Diet Assoc 101:A9, 2001
16. DeWitt RC, Kudsk KA. The gut's role in metabolism, mucosal barrier function, and gut immunology. Infect Dis Clin North Am 13:465-481, 1999
17. Cataldi-Betcher EL, Seltzer MH, Slocum BA, et al. Complications occurring during enteral nutrition support: A prospective study. JPEN 7:546-552, 1983
18. Kohn-Keeth C. How to keep feeding tubes flowing freely. Nursing 30:58-59, 2000
19. Welch SK, Hanlon MD, Waits M, et al. Comparison of four bedside indicators used to predict duodenal feeding tube placement with radiography. JPEN 18:525-530, 1994
20. Guenter PA, Settle RG, Perlmutter S, et al. Tube feeding-related diarrhea in acutely ill patients. JPEN 15:277-280, 1991
21. Mallampalli A, McClave SA, Snider HL. Defining tolerance to enteral feeding in the intensive care unit. Clin Nutr 19:213-215, 2000
22. McClave SA, Snider HL, Lowen CC, et al. Use of residual volume as a marker for enteral feeding intolerance: Prospective blinded comparison with physical examination and radiographic findings. JPEN 16:99-105, 1992
23. Ideno KT, Feghali S, Leachman R, et al. Green Discoloration in a Tube Fed Patient. IN A.S.P.E.N. 15th Clinical Conference Proceedings, vol 373, A.S.P.E.N., Silver Springs, MD, 1991
24. Ideno KT, Dedo YL. Alternatives to food coloring in enteral tube feedings. Crit Care Nurse 13:20-21, 1993
25. Metheny NA, Clouse RE. Bedside methods for detecting aspiration in tube-fed patients. Chest 111:724-731, 1997
26. Lord L, Trumbore L, Zaloga G. Enteral nutrition implementation and management. IN Kohn-Keeth C, ed, The A.S.P.E.N. nutrition support practice manual. A.S.P.E.N., Silver Spring, MD, 1998, pp 5-1-5-15
27. Ehrig F, Waller S, Misra M, et al. A case of ‘green urine’. Nephrol Dial Transplant 14:190-192, 1999
28. Zillich AJ, Kuhn RJ, Petersen TJ. Skin discoloration with blue food coloring. Ann Pharmacother 34:868-870, 2000
29. Maloney JP, Halbower AC, Fouty BF, et al. Systemic absorption of food dye in patients with sepsis [Letter]. N Engl J Med 343:1047-1048, 2000
30. Guenter P, Ericson M, Jones S. Enteral nutrition therapy. Nurs Clin North Am 32:651-668, 1997
31. Heyland DK, Cook DJ, Guyatt GH. Enteral nutrition in the critically ill patient: A critical review of the evidence. Intensive Care Med 19:435-442, 1993
32. Thelan LA, Davie JK, Urden L. Textbook of Critical Care Nursing. Mosby, St Louis, MO, 1990, p 489
33. Metheny N, Reed-Smith L. Prevention of aspiration pneumonia: A research-based protocol. Dimens Crit Care Nurs 15:263, 1996
34. Elpern EH. Pulmonary aspiration in hospitalized adults. Nutr Clin Pract 12:5-13, 1997
35. Zaloga GP. Early enteral nutritional support improves outcome: Hypothesis or fact? Crit Care Med 27:259-261, 1999
36. McClave SA, Greene LM, Snider HL, et al. Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN 21:14-20, 1997
37. Cerra F, Benitez MR, Blackburn GL, et al. ACCP Consensus Statement. Applied Nutrition in ICU patients. Chest 111:769-778, 1997
38. Shikora SA, Ogawa AM. Enteral nutrition and the critically ill. Postgrad Med J 72:395-402, 1996
39. Dusek JL. Iced gastric lavage slows bleeding in gastric hemorrhage. Crit Care Nurse 4:8, 1984
40. Leather RA, Sullivan SN. Iced gastric lavage: A tradition without foundation. CMAJ 136:1245-1247, 1987
41. Andrus CH, Ponsky JL. The effects of irrigant temperature in upper gastrointestinal hemorrhage: A requiem for iced saline lavage. Am J Gastroenterol 82:1062-1064, 1987
42. Hamelberg W, Bosomworth P. Aspiration pneumonitis: Experimental studies and clinical observations. Anesthesia and Analgesia 43:668-677, 1964
43. Schanker LS, Enna SJ, Burton JA. Enhancement of pulmonary drug absorption in the rat by bromphenol blue and related dyes. Xenobiotica 7:521-528, 1977
44. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 215:503-513, 1992
45. Sacks GS, Brown RO, Teague D, et al. Early nutrition support modifies immune function in patients sustaining severe head injury. JPEN 19:387-392, 1995
46. Moore FA, Feliciano DV, Andrassy RJ, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216: 172-183, 1992
47. Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut 39:833-835, 1996
48. Taylor SJ, Fettes SB, Jewkes C, et al. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 27:2525-2531, 1999
49. Carr CS, Ling KD, Boulos P, et al. Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 312:869-871, 1996
50. Esparza J, Boivin MA, Hartshorne MF, et al. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intensive Care Med 27:660-664, 2001
51. Montecalvo MA, Steger KA, Farber HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team. Crit Care Med 20:1377-1387, 1992
52. MacLaren R, Kuhl DA, Gervasio JM, et al. Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study. Crit Care Med 28:438-444, 2000
53. Peng YZ, Yuan ZQ, Xiao GX. Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. Burns 27:145-149, 2001
54. Kompan L, Kremzar B, Gadzijev E, et al. Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med 25:157-161, 1999
55. Fukatsu K, Zarzaur BL, Johnson CD, et al. Lack of enteral feeding increases expression of E-selectin after LPS challenge. J Surg Res 97:41-48, 2001
56. Kocan MJ, Hickisch SM. A comparison of continuous and intermittent enteral nutrition in NICU patients. J Neurosci Nurs 18:333-337, 1986
57. Winterbauer RH, Durning RB Jr, Barron E, et al. Aspirated nasogastric feeding solution detected by glucose strips. Ann Intern Med 95:67-68, 1981
58. Liu DW MR, Watters JM. Pulmonary aspiration in criticallly ill patients receiving enteral feeding [Abstract]. Clin Invest Med 22:B119, 1989
59. Montejo-Gonzalez JC, Perez-Cardenas MD, Fernandez-Hernandez AI, et al. Detecting pulmonary aspiration of enteral feeding in intubated patients [Letter]. Chest 106:1632-1633, 1994
60. Metheny NA, Dahms TE, Stewart BJ, et al. Efficacy of dyestained formula in detecting pulmonary aspiration. Chest (in press)
61. Davis D, Thompson A, Shevlin D, et al. Green discoloration of an adult patient possibly due to an enteral feeding additive [Abstract]. American Society of Health Systems Pharmacists Mid-Year Clinical Meeting, American Society of Health-Systems Pharmacists, Bethesda, MD, 1991
62. Walker J, Hamalin D. Skin and urine discoloration as a possible, rare complication to the use of FD&C #1 blue food coloring dye in enteral feeding [Abstract #16]. 1997; 21st Clinical Congress proceedings: Program Syllabus.
63. Chin RG, Calderon Y. Acute cyanide poisoning: A case report. J Emerg Med 18:441-445, 2000
64. Reyes FG, Valim MF, Vercesi AE. Effect of organic food colours on mitochondrial respiration. Food Addit Contam 13:5-11, 1996
65. Bjarnason I, MacPherson A, Hollander D. Intestinal permeability: An overview. Gastroenterology 108:1566-1581, 1995
66. Liverani E, Silveri NG, Gasbarrini G, et al. Intestinal permeability increases with the severity of abdominal trauma: A comparison between gas liquid chromatographic and enzymatic method. Hepatogastroenterology 47:1037-1041, 2000
67. Roumen RM, van der Vliet JA, Wevers RA, et al. Intestinal permeability is increased after major vascular surgery. J Vasc Surg 17:734-737, 1993
68. Deitch E. Intestinal permeability is increased in burn patients shortly after injury. Surgery 107:411-416, 1990
69. Roumen RM, Hendriks T, Wevers RA, et al. Intestinal permeability after severe trauma and hemorrhagic shock is increased without relation to septic complications. Arch Surg 128:453-457, 1993
70. Doig CJ, Sutherland LR, Sandham JD, et al. Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients. Am J Respir Crit Care Med 158:444-451, 1998
71. O'Dwyer ST, Michie HR, Ziegler TR, et al. A single dose of endotoxin increases intestinal permeability in healthy humans. Arch Surg 123:1459-1464, 1988
72. Sigthorsson G, Crane R, Simon T, et al. COX-2 inhibition with rofecoxib does not increase intestinal permeability in healthy subjects: A double blind crossover study comparing rofecoxib with placebo and indomethacin. Gut 47:527-532, 2000
73. Johnston SD, Smye M, Watson RG. Intestinal permeability and morphometric recovery in coeliac disease. Lancet 358:259-260, 2001
74. Meddings JB. Intestinal permeability in Crohn's disease. Aliment Pharmacol Ther 11(Suppl 3):47-56, 1997
75. Hendriks HJ, van Kreel B, Forget PP. Effects of therapy with lansoprazole on intestinal permeability and inflammation in young cystic fibrosis patients. J Pediatr Gastroenterol Nutr 33:260-265, 2001
76. Zarzaur BL, Kudsk KA. The mucosa-associated lymphoid tissue structure, function, and derangements. Shock 15:411-420, 2001
77. Hanna MK, Kudsk KA. Nutritional and pharmacological enhancement of gut-associated lymphoid tissue. Can J Gastroenterol 14(Suppl D):145D-151D, 2000
78. FDA. FD&C Blue No. 1. Federal Register 47:42563-42566, 1982
79. Sako F, Kobayashi N, Watabe H, et al. Cytotoxicity of food dyes on cultured fetal rat hepatocytes. Toxicol Appl Pharmacol 54:285-292, 1980
80. Hansen WH, Fitzhugh OG, Nelson AA, et al. Chronic toxicity of two food colors, brilliant blue FCF and indigotine. Toxicol Appl Pharmacol 8:29-36, 1966
81. Grasso P, Golberg L. Early changes at the site of repeated subcutaneous injection of food colourings. Food Cosmet Toxicol 4:269-282, 1966
82. Lewis RJ. Food Additives Handbook. New York: Van Nostrand Reinhold, 1986, pp 1-9
83. Mannell WA, Grice HC. Chronic toxicity of brilliant blue FCF, blue VRS, and green S in rats. J Pharm Pharmacol 16:56-59, 1964
84. Borzelleca JF, Depukat K, Hallagan JB. Lifetime toxicity/carcinogenicity studies of FD & C Blue No. 1 (brilliant blue FCF) in rats and mice. Food Chem Toxicol 28:221-234, 1990
85. Phillips JC, Mendis D, Eason CT, et al. The metabolic disposition of 14C-labelled green S and Brilliant Blue FCF in the rat, mouse and guinea-pig. Food Cosmet Toxicol 18:7-13, 1980
86. Hess S, Fitzhugh OG. Absorption and excretion of certain triphenylmethane colors in rats and dogs. J Pharmacol Exp Ther 114:38-42, 1955
87. Brown JP, Dorsky A, Enderlin FE, et al. Synthesis of 14Clabelled FD & C Blue No. 1 (Brilliant Blue FCF) and its intestinal absorption and metabolic fate in rats. Food Cosmet Toxicol 18:1-5, 1980
88. Hess SM, Fitzhugh OG. Metabolism of coal tar dyes. I. Triphenylmethane dyes. Fed Proc 12:330-331, 1953
89. Iga T, Awazu S, Nogami H. Pharmacokinetic study of biliary excretion. II. Comparison of excretion behavior in triphenylmethane dyes. Chem Pharm Bull (Tokyo) 19:273-81, 1971
90. Werth G, Boiteux A. [Toxicity of triphenylmethane dyes. Malachite green as an uncoupling agent of oxidative phosphorylation in vivo and in vitro]. Arch Toxicol 23:82-103, 1968
91. Noda K, Yoshimoto M, Hatano S, et al. Effect of coal tar dyes on oxygen uptake in mitochondria isolated from rat liver. J Food Hyg Soc Japan 26:203-207, 1985
92. Lu FC, Lavalle A. The acute toxicity of some synthetic colors used in drugs and foods. Can Pharm J 97:30, 1964
93. Beyhl FE. Interaction of organic dyes with hepatic microsomal drug-metabolizing monooxygenases in vitro. Experientia 37:943-945, 1981
94. Samizo K, Ishikawa R, Nakamura A, et al. A highly sensitive method for measurement of myosin ATPase activity by reversedphase high-performance liquid chromatography. Anal Biochem 293:212-215, 2001
95. Clay AS, Behnia M, Brown KK. Mitochondrial disease: A pulmonary and critical-care medicine perspective. Chest 120:634-648, 2001
96. Peter C, Hongwan D, Kupfer A, et al. Pharmacokinetics and organ distribution of intravenous and oral methylene blue. Eur J Clin Pharmacol 56:247-250, 2000
97. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med 34:646-656, 1999
98. Kirov MY, Evgenov OV, Evgenov NV, et al. Infusion of methylene blue in human septic shock: A pilot, randomized, controlled study. Crit Care Med 29:1860-1867, 2001
99. Werth VG, Boiteux A. Zur biologischen Wirkung von Malachitgrun. Arzneimittel-Forschun 17:1231-1237, 1967
100. Forstermann U, Pollock JS, Schmidt HH, et al. Calmodulindependent endothelium-derived relaxing factor/nitric oxide synthase activity is present in the particulate and cytosolic fractions of bovine aortic endothelial cells. Proc Natl Acad Sci USA 88:1788-1792, 1991
101. Thomson AB, Keelan M, Thiesen A, et al. Small bowel review: Normal physiology part 1. Dig Dis Sci 46:2567-2587, 2001
102. Zaloga GP, Marik P. Promotility agents in the intensive care unit. Crit Care Med 28:2657-2659, 2000