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The gastrointestinal tract generally tolerates feedings quite well once any postoperative ileus is resolved. Not uncommonly, however, a critically ill child will sustain a loss of a significant portion of the absorptive function, often due to acquired lactase deficiency. Symptoms are generally manifested by cramping, diarrhea, or emesis.:Pravachol Symptoms will often improve with the initiation of a lactose-free diet. Other alterations in the administration of the diet can also improve feeding tolerance. First, the gastrointestinal tract generally tolerates increased volume more readily than increased osmolarity. Therefore, adverse symptoms can be avoided by initiating 1/8 or 1/4 strength formula and slowly advancing the formula concentration. Second, administration of formula by continuous drip may be better tolerated than bolus feedings. The risk of gastroesophageal reflux and dumping symptoms are thereby greatly reduced. Third, care must be taken to ensure the enteral formula does not become contaminated, either during preparation or at the bedside. Expiration dates should be carefully observed. Finally, pectin, Metamucil, lomotil, paregoric, or Imodium may be required for those who have lost a significant amount of their bowel length (see the  Short Bowel Syndrome  section:Pravachol). Assessment of absorptive capacity can be done most readily by testing stool for the absorption of carbohydrates. This is done by measuring stool pH and checking for reducing substances. Stool pH less than or equal to 5.5, or a reducing substance of greater than one-half percent, indicates the passage of unabsorbed carbohydrates into the stool. Once demonstrated, these findings are best treated by decreasing the formula concentration of carbohydrate.