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.[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.