LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
"Jan Ellen Brown RDH, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 24 Feb 1999 21:03:09 EST
Content-Type:
text/plain
Parts/Attachments:
text/plain (59 lines)
Dear Jean,
    In response to your question about cystic fibrosis and foul-smelling
stools:  I, too, thought about this when I read the post but I think I
remember that weight gain was ok and stools did not appear greasy.

    In State Of The Art: Cystic Fibrosis by Davis, Drumm and Konstan (my
daughter's doctor last year!) in Am J Crit Care Med Vol 154 pp 1129-1256,
1996:
"The gold standard" for diagnosis of pancreatic insufficiency (PI) is the
demonstration of inadequate enzyme and bicarbonate output from the pancreas
into the duodenum after secretin stimulation by collection of the pancreatic
output via a triple-lumen tube placed in the duodenum.

    However, this complication is so prevalent that seldom is such an invasive
test required for clinical purposes.  Documentation of steatorrhea by 72 h
stool collection on a controlled diet is also diagnostic but it may be
sufficient simply to demonstrate fat globules in the stool on Sudan stain, or
reduced serum carotene levels, abnormal serum trypsinogen, or reduced
excretion of para-aminobenzoic acid (PABA) in the urine after oral
administration of benzyl-tyrosyl (PABA).

    Once the diagnosis is established, pancreatic insufficiency in most
patients is readily treated by provision of pancreatic enzyme supplements
available in encapsulated microspheres to avoid destruction by gastric acid
and to allow enzyme release in the small intestine,where pH is more favorable
for activity."

    As they point out, (and they are in your home state, Jean, at Rainbow/Case
Western in Cleveland) these enzymes are specific for pancreatic insufficiency
and are available only by prescription.  Recently, in Charlotte, a 4 month old
who was negative for the sweat test, (where elevated sodium chloride levels
are usually diagnostic) the other diagnostic and main test for CF,  was put on
them anyway to see if they would help.  So, to answer your question, some docs
will try prescription enzymes to see if they help, not necessarily diagnose.

    The babies I have worked with and the moms I have talked with usually
recall  roof-raising odor to the stools.  On CF day at the hospitals I have
been to all have the telltale odor in the restroom.  Even when steatorrhea is
improved, there is still an odor for a lot of patients.  When I ask my
daughter's first CF doc, "When will she have a normal stool?"  I'll never
forget his response, "She'll NEVER have a normal stool!"

    One more thing, PI sneaks up on these babies, meaning they may not
demonstrate malabsortion-maldigestion immediately (esp. w/ lipase in Mother's
milk)
but it can happen anytime.  The stools can be yellow or "normal", green,
frothy, greasy. bulky, bluish etc.  But the odor is usually pretty apparent
once pancreatic insufficiency becomes a factor. And  a lot of gas. The other
symptom I usually see is an adequate and often times "over" milk supply, with
slow or FTT in the baby.

    Hope this helps.  Most peds will just start out with the sweat test.  The
baby in question also went awhile without stooling, which is just usually the
opposite with PI.  Please feel free to contact me if I can be of help with
other questions.  My references are all here at my house.

Jan Ellen Brown RDH, IBCLC
Charlotte, NC USA

ATOM RSS1 RSS2