Steatorrhea medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Steatorrhea}} | {{Steatorrhea}} | ||
{{CMG}}; {{AE}}{{Vbe}} | {{CMG}} ; {{AE}} {{Vbe}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Management of [[steatorrhea]] include treatment of underlying etiology, control of [[diarrhea]] and correction of [[nutritional deficiencies]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Management of [[steatorrhea]] include treatment of underlying etiology, control of [[diarrhea]] and correction of [[nutritional deficiencies]].<ref name="pmid2509353">{{cite journal |vauthors=Marotta RB, Floch MH |title=Dietary therapy of steatorrhea |journal=Gastroenterol. Clin. North Am. |volume=18 |issue=3 |pages=485–512 |year=1989 |pmid=2509353 |doi= |url=}}</ref><ref name="pmid5917827">{{cite journal |vauthors= |title=Varieties of steatorrhea |journal=Br Med J |volume=2 |issue=5524 |pages=1214–5 |year=1966 |pmid=5917827 |pmc=1944784 |doi= |url=}}</ref><ref name="pmid8878143">{{cite journal |vauthors=Koch J, Garcia-Shelton YL, Neal EA, Chan MF, Weaver KE, Cello JP |title=Steatorrhea: a common manifestation in patients with HIV/AIDS |journal=Nutrition |volume=12 |issue=7-8 |pages=507–10 |year=1996 |pmid=8878143 |doi= |url=}}</ref> | |||
=== Correction of Nutritional Deficiencies === | |||
* Oral supplementation with vitamins and minerals is usually well tolerated in patients who are are undergoing specified treatment for underlying etiology. | |||
* Rapid recovery following the identification of a nutritional deficiency can be achieved by supplementation with 5 to 10 times the Recommended Dietary Allowance. | |||
** Preferred regimen (1) : [[Vitamin A]] 40,000 to 50,000 units q12h | |||
*** Note : Maintenance: 8000 to 20,000 units/day (dosage ≥15,000 units can be [[teratogenic]]) | |||
** Preferred regimen (2) : [[Vitamin D3]] ([[cholecalciferol]]) 30,000 to 50,000 units q24h | |||
** Preferred regimen (3) : [[Vitamin K]] 2.5 to 12.5 mg q24h | |||
** Preferred regimen (4) : [[Folic acid]] 5 mg q24h during repletion | |||
** Preferred regimen (5) : [[Vitamin B12]] ([[cyanocobalamin]]) 1 mg [[Subcutaneous|subcutaneously]] | |||
** Preferred regimen (6) : [[Ferrous sulfate]] 325 mg (65 mg elemental [[iron]]) q8h | |||
** Preferred regimen (7) : [[Magnesium gluconate]] 1 to 4 g (54 to 216 mg elemental [[magnesium]]) q6h | |||
** Preferred regimen (8) : [[Calcium carbonate]] 500 mg (elemental [[calcium]]) q12h | |||
=== | === Antidiarrheal agents === | ||
*Preferred regimen (1) : [[Loperamide]] 2 to 4 mg as needed, not to exceed 12 mg/day | |||
*Preferred regimen (1) : [[Diphenoxylate and Atropine|Diphenoxylate with atropine]] ([[Lomotil]]) 1 to 2 tabs after loose stool, not to exceed 8 per day | |||
*Preferred regimen (1) : [[Opium Deodorized|Deodorized opium tincture]] 10 percent (10 mg per mL) 0.3 to 0.6 mL q8h | |||
=== Bile acid binding resins === | |||
:* Preferred regimen (1) : [[Cholestyramine]] 4 g three times daily | |||
:* Preferred regimen (1) : [[Colestipol]] granules 5 to 10 g three times daily | |||
:** Note: Administer ≥1 hour before or >4 hours after other drugs to prevent decreased absorption of other drugs. | |||
===Pancreatic enzymes=== | |||
* Preferred regimen (1) : Pancrelipase delayed-release capsules (Creon minimicrospheres) | |||
* Preferred regimen (1) : [[Pancrelipase]] tablets and powder (Viokase) 1 g | |||
* (equivalent to 20,000 units [[lipase]] component) with meals | |||
** Note: Approximately 30,000 units (90,000 USP) ([[lipase]] component) with each meal. | |||
* | |||
** | |||
* | |||
* | |||
* | |||
** | |||
=== | === Management of Underlying Etiologies === | ||
* ' | * For a detailed explanation of management of Crohn's disease click [[Crohn's disease medical therapy|here]] | ||
* For a detailed explanation of management of celiac disease click [[Celiac disease medical therapy|here]] | |||
* For a detailed explanation of management of gallstones disease click [[Gallstone disease medical therapy|here]] | |||
* For a detailed explanation of management of cystic fibrosis disease click [[Cystic fibrosis medical therapy|here]] | |||
* | * For a detailed explanation of the management of small bowel bacterial overgrowth syndrome click [[Small intestinal bacterial overgrowth syndrome|here]] | ||
* | |||
* | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 23:56, 11 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]
Overview
Management of steatorrhea include treatment of underlying etiology, control of diarrhea and correction of nutritional deficiencies.
Medical Therapy
Management of steatorrhea include treatment of underlying etiology, control of diarrhea and correction of nutritional deficiencies.[1][2][3]
Correction of Nutritional Deficiencies
- Oral supplementation with vitamins and minerals is usually well tolerated in patients who are are undergoing specified treatment for underlying etiology.
- Rapid recovery following the identification of a nutritional deficiency can be achieved by supplementation with 5 to 10 times the Recommended Dietary Allowance.
- Preferred regimen (1) : Vitamin A 40,000 to 50,000 units q12h
- Note : Maintenance: 8000 to 20,000 units/day (dosage ≥15,000 units can be teratogenic)
- Preferred regimen (2) : Vitamin D3 (cholecalciferol) 30,000 to 50,000 units q24h
- Preferred regimen (3) : Vitamin K 2.5 to 12.5 mg q24h
- Preferred regimen (4) : Folic acid 5 mg q24h during repletion
- Preferred regimen (5) : Vitamin B12 (cyanocobalamin) 1 mg subcutaneously
- Preferred regimen (6) : Ferrous sulfate 325 mg (65 mg elemental iron) q8h
- Preferred regimen (7) : Magnesium gluconate 1 to 4 g (54 to 216 mg elemental magnesium) q6h
- Preferred regimen (8) : Calcium carbonate 500 mg (elemental calcium) q12h
- Preferred regimen (1) : Vitamin A 40,000 to 50,000 units q12h
Antidiarrheal agents
- Preferred regimen (1) : Loperamide 2 to 4 mg as needed, not to exceed 12 mg/day
- Preferred regimen (1) : Diphenoxylate with atropine (Lomotil) 1 to 2 tabs after loose stool, not to exceed 8 per day
- Preferred regimen (1) : Deodorized opium tincture 10 percent (10 mg per mL) 0.3 to 0.6 mL q8h
Bile acid binding resins
- Preferred regimen (1) : Cholestyramine 4 g three times daily
- Preferred regimen (1) : Colestipol granules 5 to 10 g three times daily
- Note: Administer ≥1 hour before or >4 hours after other drugs to prevent decreased absorption of other drugs.
Pancreatic enzymes
- Preferred regimen (1) : Pancrelipase delayed-release capsules (Creon minimicrospheres)
- Preferred regimen (1) : Pancrelipase tablets and powder (Viokase) 1 g
- (equivalent to 20,000 units lipase component) with meals
- Note: Approximately 30,000 units (90,000 USP) (lipase component) with each meal.
Management of Underlying Etiologies
- For a detailed explanation of management of Crohn's disease click here
- For a detailed explanation of management of celiac disease click here
- For a detailed explanation of management of gallstones disease click here
- For a detailed explanation of management of cystic fibrosis disease click here
- For a detailed explanation of the management of small bowel bacterial overgrowth syndrome click here
References
- ↑ Marotta RB, Floch MH (1989). "Dietary therapy of steatorrhea". Gastroenterol. Clin. North Am. 18 (3): 485–512. PMID 2509353.
- ↑ "Varieties of steatorrhea". Br Med J. 2 (5524): 1214–5. 1966. PMC 1944784. PMID 5917827.
- ↑ Koch J, Garcia-Shelton YL, Neal EA, Chan MF, Weaver KE, Cello JP (1996). "Steatorrhea: a common manifestation in patients with HIV/AIDS". Nutrition. 12 (7–8): 507–10. PMID 8878143.