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Consider sodium load when treating phytobezoars with Adolph's Meat Tenderizer

From the July 2,1997 Issue

PROBLEM: During an esophagogastroduodenoscopic (EGD) procedure, a physician visualized a phytobezoar (undigested food material) in the antrum of the stomach. The physician decided to prescribe Adolph's Meat Tenderizer to dissolve it. Adolph's contains papain, a proteolytic enzyme that has been used effectively in treating phytobezoars. Since it is a food product, the physician considered Adolph's as, more or less, a benign substance. Without checking for the proper dose, he prescribed 4 tablespoonsful of the powder, asking nurses to prepare the powder in 250 mL water. They instilled 125 mL, waited an hour, then suctioned the stomach and repeated the procedure. This was repeated 4 times until the patient became violently ill. His serum sodium measured 186 mEq/L, which was attributed to the administration of Adolph's. The patient was successfully treated, although he did require hospitalization in the ICU for fluid and diuretic administration. The correct dose is measured in teaspoons rather than tablespoons, and it's usually given only 2-3 times.

SAFE PRACTICE RECOMMENDATION:Health professionals may not be familiar with the fact that Adolph's contains enormous amounts of sodium. The amount of sodium per teaspoonful of powder is not mentioned on the product label. The label states only that Adolph's contains salt when it actually contains 1800 mg of sodium (78 mEq) per teaspoonful. If papain is needed, consider using an alternative source such as one of the papain products available in health food stores.

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