MEDICATION ABSORPTION ? Oral medication absorption is often impaired and larger doses, intravenous, or sublingual delivery may be required; significant interpatient variability may be observed.
? The provision of medications to the patient with SBS can represent a challenge to the practicing clinician. Just as fluid and nutrient absorption is impaired, medication absorption is often impaired as well. As with nutrient absorption, significant interpatient variability may be observed. Given that the risk for catheter sepsis is greater the more times the line is manipulated, it is important to use the oral or enteral route for medication delivery whenever possible. The degree to which a medication is malabsorbed is dependent upon several variables. These include the surface area and health of the residual intestinal surface area, morphologic and physiologic factors, including the presence or absence of the terminal ileum (B12 and bile salt absorption?necessary for cyclosporin absorption), or the presence of an acidic or alkaline environment (related to the use of H2 blockers in TPN or use of proton pump inhibitors). Many, but not all, medications are absorbed in the jejunum; so, for many medications, absorption will be minimally impacted in the absence of decreased intestinal transit time, which will decrease mucosal contact time. Most of the available data on oral medication absorption in patients with SBS is in the form of isolated case reports
