S.D., a 29-year-old woman, was admitted to the hospital 65 days ago after a motor vehicle crash. She sustained multiple traumatic injuries and exhibited multiple complications. S.D. has undergone several exploratory laparotomies and has been treated for multiple infections, including pneumonia, sepsis, and wound infection. She has been treated for Clostridium difficile diarrhea but has not had diarrhea since therapy was completed 3 weeks ago. Lysis of adhesions, closure of an enterocutaneous fistula, and placement of a feeding jejunostomy tube (J tube) were done during the last laparotomy 8 days ago. Enteral feedings were started through her J tube 3 days ago and advanced to the goal rate of 80 mL/hour within 36 hours. The EN provides 35 kcal/kg/day and 1.75 g protein/kg/day, which is less than her protein requirement based on nitrogen balance. She has received PN for nutrition support during most of her hospitalization and the PN rate was decreased as EN increased. S.D. now has diarrhea, which started approximately 18 hours after her EN was increased to goal rate. What is the likely cause of the diarrhea? What other information related to the EN regimen would be helpful to determine if the EN should be stopped and the parenteral nutrition formulation restarted
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