Steatorrhea medical therapy
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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]
Overview
Medical Therapy
Management of steatorrhea include treatment of underlying etiology , control of diarrhea and correction of nutritional deficiencies.
Correction of Nutritional Deficiencies
- 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 (should be repeated x three over first week of repletion)
- Preferred regimen (6) : Ferrous sulfate 325 mg (65 mg elemental iron) three times daily
- Preferred regimen (7) : Magnesium gluconate 1 to 4 g (54 to 216 mg elemental magnesium) four times daily
- Preferred regimen (8) : Calcium carbonate 500 mg (elemental calcium) twice daily
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 three times daily
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.
Management of Underlying Etiologies
Pancreatic enzymes
- Preferred regimen (1) : Pancrelipase delayed-release capsules (Creon minimicrospheres)
- Preferred regimen (1) : Pancrelipase tablets and powder (Viokase, others) 1 g (equivalent to 20,000 units lipase component) with meals
- Note: Approximately 30,000 units (90,000 USP) (lipase component) with each meal