Hello,

Hx:  mother/baby demonstrating hyperlactation syndrome
- advised all the usual things, resolved for about one week, then
started up again (baby symptoms, gassy/fussy +++, green liquid
stools), mom confesses she only reduced dairy and did not eliminate,
doctor has told her that it was improper burping and advised pumping
and putting in bottles to solve the rapid MER, says "milk is milk"
when mom talked about foremilk/hindmilk imbalance.  arghhhh! So mom
is doubting my advice and going with doc's suggestions. Anyway - she
brought diapers to show doc and said there was blood in diaper. I
suspected not in a two-month old and she showed me, it is "brick
dust" (uric acid crystals), My question is "Why the brick dust at two
months?"  I have seen the stool diapers and they are green and little
solid material and +++ water.  I worked in a nursery for years and
saw lots of uric acid crystals until mom's volume increased and
thought that it just ment concentration of urine (my colleagues
always and still think it is a sign of dehydration).  Anyway could
this be concentrated urine because there is a lot of water loss in
the stool?  The only other time I have seen this was in a 4 month old
who turned out to be highly allergic, and ended up with blood in
stool.  I think I'm trying to make a connection between allergic
response (in the infant's gut)to cow milk protein in mother's milk and
inability to digest the lactose - thus the constant rapid transit and
water loss.  I'm not sure if mother will go back to no dairy.  I
think she is leaning on following doctor's advice.  Even though she
had a good week on mine!  I provided Dr.Newman's handout and Dr.
Verity Livingston's article about hyperlactation (Can.Fam.Physician,
1996) for the doctor with an explanation about LC's usual advice for
these issues.  But I haven't heard back.  Any ideas about the brick
dust?

Nancy Nurmi  RN,BScN,NP,IBCLC
(working P/T as one of 2 RNs in clinic with 40 doctors - slowly
and gently exposing my skills to the GPs so as not to frighten them
off!)