Pancreatine administration

Question

What are the exact effects of
a) an over-dosage of pancreatic enzymes
b) an under-supply of pancreatic enzymes?

Answer

Hello,

there are certain guidelines about the dosage of the pancreatic enzymes in CF therapy. The enzyme dosage should be based on the scheduled food intake. The demand varies individually, so that a dosage of 1,500 to 2,500 units of lipase per gram of nutritional fat should be calculated (Dose requirements can vary widely between 500 and 4000 IU lipase per gram diatary fat). However, the total daily dosage should not exceed 10,000 units of lipase per kilogram body weight.

The only effect of an over-dosage of enzymes that has been described up until now is the so-called fibrosing colopathy—severe inflammatory modifications in the final centimetres of the small intestine, and especially also in the large intestine, which have lead to intestinal bleeding and particularly to intestinal stenosis.

The effects of an under-supply are manifold:

Clinical ailments such as flatulence, voluminous and foul-smelling stools, ravenous appetite, and insufficient weight gain or even delayed growth are predominant. Chronic under-supply leads to deficiency in fat-soluble vitamins and proteins, a loss of bile acid, and liver damage. Therefore, it is very important to determine the right adjustment of the pancreatic enzyme substitute through, among other things, measuring the stool fat expulsion in a 3x24-hour stool collection [translator’s comment: could not find a better translation]. This analysis should be combined with an exact dietary record.

Kind regards,
Dr. H.-G. Posselt

04.12.2008