W10 Lactose Intolerance (MAH) Flashcards
Lactose
Lactose intolerance is a clinical syndrome that manifests with characteristic signs and symptoms upon consuming food substances containing lactose
What Foods contain lactose?
Dairy products include:
milk
butter
cheese
cream
yoghurt
ice cream
Many processed foods can also
contain lactose, including:
cereals
baked foods like bread, crackers, cakes, biscuits, and pastry sauces and salad dressings diet and protein shakes
Lactose metabolism / intolerance
Lactose- Lactase breaks downs into glucose and galactose
Lactose- No lactase- Bacteria ferment- acids and gases- irritation caused
functions of galactose contribute to the developemental organisation for neurological, structural, physical development
Lactose intolerance signs and symptoms?
- starts in infancy
- abdominal pain
- diarrhoea
- vomiting
- flatulence
- malabsorption
- failure to thrive in infants
- stool pH is low (due to lactic acid)
- asymptomatic when lactose is removed from the diet
Diagnostic tests for lactose intolerance? (4)
- Hydrogen breath test: avoid eating or drinking during the night before the test, baseline Hydrogen (ppm) taken: blow up a balloon-like bag, drink lactose solution»_space;> breath tested every 15 minutes over a few hours to see if the level of hydrogen changes. If your breath contains a large amount of hydrogen (more than 20ppm above your baseline) after consuming the lactose solution, it’s likely that you’re lactose intolerant.
- Lactose tolerance test: Baseline [Glucose], lactose drink, another [glucose] should rise unless lactose intolerant
- Milk tolerance test: Baseline [Glucose], 500 ml milk, another [glucose] should rise unless lactose intolerant
- Small bowel biopsy: rare but used to query coeliac disease. Endoscope under local anaesthetic check for lactase and inflammation
Treatment
- Lactase substitutes may also be helpful. These are drops or tablets you can take with your meals or drinks to improve your digestion of lactose.
- Depending on what dairy products you’re able to eat, you may also require
additional calcium and vitamin D supplements
Complications of lactose intolerance
- Milk and other dairy products contain calcium, protein and vitamins such as A, B12 and D.
Lactose also helps your body absorb magnesium and zinc - Osteopenia – very low bone-mineral density. If not treated»_space;> osteoporosis
- Osteoporosis – bones are thin and weak»_space;> risk of fractures and broken bones is increased
- Malnutrition – wounds can take longer to heal and you may start to feel tired or depressed
Lactose intolerant Neonates
- True lactose intolerance is rare in neonates typically only starts showing up after age three in children who were born full-term.
- Babies who were born premature are more likely to have a type of lactose intolerance called developmental lactase deficiency
- All babies are born with lactase in their intestines. As they grow older, the lactase enzyme decreases.
- Premature babies generally exclusively fed with expressed breast milk (Mum or Donor)
- Symptoms present on NICU but lactose intolerance diagnosed until discharge
- Premature neonates develop a milk allergy after 32 weeks of corrected gestational age, suggesting that the development of milk allergy requires a certain degree of immunological
maturation
Additional s /s
* bloody stools
* repeated vomiting
* diminished sucking
* abdominal distension
* High pitched cry
BNF C Specialised formulas: Infant and child
* First try…. Then try lactose free milk formulations
Infacol- simeticone 40mg per 1ml oral suspension
Colief- lactase enzyme drops
sma- soy infant formula
sma- lactose free infant milk
Arla lacto free milk (2+ weeks)
- Symptoms presenting in infants with feeding difficulties are often non-specific and conditions can
- overlap. The majority of infants presenting with restlessness, colic and crying do not have CMA.
- Parents of an infant should be offered reassurance and advice on managing common and natural
- problems like colic, constipation, reflux, lactose intolerance or overload
Diagnosis is important
Cows’ milk protein allergy is an immune-mediated allergic response to the proteins in milk. It can
be immediate in onset following consumption, referred to as IgE mediated or a non-IgE mediated
reaction when the presentation is delayed by hours or even days following exposure.
Food allergy should not be confused with food intolerance, which is a non-immunological reaction
that can be caused by enzyme deficiencies, pharmacological agents and naturally occurring
substances.
Lactose intolerance occurs when there is reduced or absence of the enzyme lactase. Lactase is
present in the lining of the small intestine. Low levels of this enzyme prevent the effective
digestion of lactose and results in loose acidic stools. The undigested lactose ferments in the colon
to produce gas and mild acid that causes discomfort and flatulence.
Specialised formulas: Infant and child:
Hydrolysate formula:
* Special characteristics: Contains meat derivatives, residual lactose, soya. Gluten-free
* ACBS indications: Cow’s milk protein allergy and other conditions where an
extensively hydrolysed formula is indicated.
Amino acid-based formula:
Specialised formulas: Infant and child:
* ACBS indications
* Cow’s milk allergy, multiple food
protein allergies and other
conditions where an elemental
diet is recommended.
* Powder provides: protein 13.3 g,
carbohydrate 52.5 g, fat 25.6 g,
energy 2062 kJ (493 kcal)/100 g.
Premature babies:
Products?
Considerations?
Post discharge nutrition for pre-term infants
Cow & Gate nutriprem 2 post discharge formula
-it should not be started in primary care
- the infant should already be under regular review by the paediatricians
-the heath visitor or suitable HCP should monitor growth (weight, length and head circumference) while the baby is on these formulas
- these products should be discontinued by six months corrected age
Growth charts:
- The growth charts are based on the WHO Child Growth Standards, which describe the optimal growth for healthy, breastfed children.
- They are suitable for babies and children from all ethnic backgrounds.
- There are separate charts for boys and girls.
- Separate page on the charts for babies born early, or preterm (before 37 weeks).
- These are called centile lines. They are based on measurements taken from many children.
- The centile lines show how one child compares with other children of the same age and sex.
- Weights and heights that are anywhere within the centile lines are considered normal.
Corrected age= chronological age- weeks premature
Neonatal lactose intolerance is caused by a deficiency in which enzyme?
Lactase
more questions.. add here when uploaded
