Malabsorption syndrome

Malabsorption syndrome Steatorrhea Tropical sprue Idiopathic hypercalcemia... 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

Chronic diarrhea lasts for longer than 4 weeks. Most cases result from functional or inflammatory bowel disorders, endocrine disorders, malabsorption syndromes and drugs (including laxative abuse). In chronic diarrhea, daily watery stools may not occur. Diarrhea may be either intermittent or persistent. 

Although diarrhea can often be attributed to a specific mechanism, some patients develop diarrhea due to overlapping mechanisms. For example, malabsorption syndromes and traveler s diarrhea are associated with both secretory and osmotic diarrhea. 

When treating folic acid deficiency, an initial daily dose of 1 mg/day by mouth typically is effective. Absorption of folic acid generally is rapid and complete. However, patients with malabsorption syndromes may require larger doses (up to 5 mg/day). Similar to vitamin B12 deficiency, resolution of symptoms and reticulocytosis is prompt, occurring within days of commencing therapy. Hgb will start to rise after 2 weeks of therapy and may take from 2 to 4 months to resolve the deficiency completely. Afterwards, if the underlying deficiency is corrected, folic acid replacement can be discontinued. However, in cases where folic acid is consumed rapidly or absorbed poorly, chronic replacement may be required. 

Pregnant or lactating women should not take orlistat because no data exist to establish safety. Orlistat is contraindicated in patients with chronic malabsorption syndrome or cholestasis.31... 

WD Heizer, TW Smith, SE Goldfinger. Absorption of digoxin in patients with malabsorption syndromes. N Engl J Med 285 257-259, 1971. 

Bacterial overgrowth Pathogenesis Gastrointestinal motility Gastric acid Malabsorption syndromes... 

Moreover, adequate nutritional support is mandatory. The aim of this therapeutic measure should be the reintegration of both caloric and vitamin requirements, often defective in these patients. The nutritional defect is caused both by the predisposing condition and by the malabsorption syndrome. 

Schiffer LM, Faloon WW, Chodos RB Malabsorption syndrome associated with intestinal diverticulosis. Gastroenterology 1962 42 63-68. 

Ghoshal U, Ghoshal UC, Ranjan P, Naik SR, Ayyagari A Spectrum and antibiotic sensitivity of bacteria contaminating the upper gut in patients with malabsorption syndrome from the tropic. BMC Gastroenterology 2003,3 9. 

Common complications of surgery for both colon and rectal cancer include infection, anastomotic leakage, obstruction, adhesions, and malabsorption syndromes. 

THE MALABSORPTION SYNDROME, WITH SPECIAL REFERENCE TO THE EFFECTS OF WHEAT GLUTEN... 

Bile salt deficiency must also be directly studied. It may occur in the absence of obstruction or obvious liver disease (R7). The majority of patients with one form or another of the sprue syndrome will be found to have pancreatic enzymes and bile salts within the normal range. Pancreatic enzymes are absent or markedly deficient in patients with pancreatogenous malabsorption syndrome (B17, F13). It is surprising how frequently this necessary step in differential diagnosis is omitted. 

Chronic diarrhea is likely to result in a disturbance of water and salt balance. This has been shown to be so in the malabsorption syndrome (C9, F5). These changes, especially potassium deficiency, may cause some aggravation of the intestinal situation and increase of abdominal distension. Some improvement in absorption may consequently occur on appropriate rehabilitation. However, a residual defect of absorption will remain until more specific therapy is instituted. 

Calcium and magnesium deficiency also occur in some patients with the malabsorption syndrome and this may lead to tetany or bone changes. Low blood calcium levels may result from decreased absorption associated with lack of effective compensatory parathyroid activity. In patients in whom secondary hyperparathyroidism is effective, extensive loss of calcium from the bones may occur. The cause of the defective absorption of calcium in patients of the sprue group is complex and not yet fully understood (B3, Dl, Jl, M7, Nl). It is important that complications such as calcium or magnesium deficiency should be corrected before the final steps of definitive diagnosis are attempted. If this is not done, the secondary effects may obscure the results of other tests. 

The change in daily output of fecal fat forms the basis for the definitive diagnostic test for gluten induced enteropathy (F16, F21). This diagnosis is justified if the patient presented with the main features of the malabsorption syndrome, if the fecal fat output fell to normal levels on a gluten-free diet, and if subsequent reintroduction of gluten into the diet caused an unequivocal increase in fecal fat... 

In the malabsorption syndrome some increase in the numbers and activity of intestinal bacteria in the lower bowel might be expected,... 

The type of antibacterial therapy used is important. No effect need be expected from the use of a single chemotherapeutic agent. Successful use has been made of a triple combination of sulfonamide, chloramphenicol, and chlortetracycline (A8). It would seem advisable to avoid neomycin (FI, J2), since this can itself cause a malabsorption syndrome. 

A2. Adlersberg, D., 25 years of progress primary malabsorption syndrome—past— present—future. Am. J. Digest. Diseases 4, 8-18 (1959). 

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