Dosage of Kreon and side effects

Question

My daughter is 5 years old and suffers from CF. She takes 2500 IU of Kreon per gram fat. We have the impression, that it has become insufficient. She has always a bloated belly, complains lately regularly about abdominal pain. She has fatty stools rarely, however sometimes up to 5 times a day. We give even more Kreon if she eats very fatty food. Our CF center is of the opinion, that this was already a very high dosage. At the moment we are on rehabilitiation and there it has been said, that we should give more, as it would be excreted and would not cause any side effects.
Our gastro-enterologist says, that a permanent overdosage could lead to thickening of the abdominal wall, what should we do?
Our daughter has had a meconium ileus after birth, therefore I do not want to cause any problems in this direction. She is on the 90th percentile with her height, weight on the 40th. I think this is with a BMI of 25 o.k. concerning the weight. Are there any side effects in the long runs if one gives clearly more, or does it not cause any problems?
Thank you very much,
Best regards,
V.M.

Answer

Dear Mrs. M.,
you report that you have the feeling, that your 5-year-old daughter needs more Kreon as you give her at the moment, as she often has flatulences and suffers from abdominal pain. Sometimes she would have up to five times stool a day, fatty stools occur rarely. The doctors of your CF center have said to you that the dosage would already be quite high and that in case of long term overdosage thickening of the abdominal walls could occur.
At the rehabilitation, that you are doing at them moment, you have been told, a higher dosage would not be a problem, as the redundant Kreon would be excreted without problems.
You report that the development of weight of your child was be good.
At first it has to be said, that the statement of the staff at the rehabilitiation center is irresponsable and wrong. In case of long term clear overdosage it can come to inflammatory changes of the abdominal wall with thickening of the abdominal wall. As a guideline the following dosages for Kreon pertain: concerning the fat content of the food 2000 up to 4000 units lipase per gram fat in the food are metioned.
In relation to the body weight of your child an upper value of 10.000 units lipase per kilogram body weight should not be exceeded, if possible. In the single case, the dosage can be increased up to 15.000 untis lipase per kilogram body weight. In case one has the feeling that the usual dosage do not suffice for a child with CF, one should urgently seek, if probably an accompanying food intolerance (lack of lactase, fructose malabsorption, gluten intolerance) or other disturbances of the gastro-intestinal tract play a role. If those causes can be excluded, the CF physicians should make a therapeutic trial with Nortase. Nortase does not have to be calculated into the total amount of lipase. Often this combination leads to an improvement of the digestion of fat.

Yours sincerely,
Dr. H.-G. Posselt

30.06.2014