#1
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Ïðî ëàêòàçíóþ íåäîñòàòî÷íîñòü
Êîëëåãè, ïðîñòèòå çà äóðàöêèé âîïðîñ. Íî ó ìåíÿ âûøåë ïðîâàë â àðãóìåíòàöèè êëèíèêè ËÍ.
ß âñåãäà ñ÷èòàë, ÷òî îäèí èç îñíîâíûõ åå ñèìïòîìîâ ó ãðóäíè÷êîâ - ýòî íåäîáîð âåñà.  ðàçãîâîðå îá ýòîì ìåíÿ ïîïðàâèëè, ÷òî íèêàê íà âåñ ËÍ íå âëèÿåò. ÿ ïåðåðûë ìåä ñàéòû è Íåëüñîíà - è ïðàâäà íå íàøåë è ñëîâà î ïëîõèõ ïðèáàâêàõ. Âûõîäèò ÿ íå ïðàâ áûë? èëè ìîæåò áûòü åñòü ññûëêà äëÿ àðãóìåíòàöèè? |
#2
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Çäðàâñòâóéòå, êîëëåãà!
ËÍ ïðîÿâëÿåòñÿ ñèíäðîìîì ìàëüàáñîðáöèè,ò.å.âîäÿíèñòîé îñìîòè÷åñêîé äèàðååé. Äèàðåÿ âåä¸ò çà ñîáîé ýêñèêîç, ãèïîòðîôèþ. Ïðîùå ãîâîðÿ ëåæèò ó ìåíÿ òàêîé áîëüíîé èìåÿ íóëåâûå èëè îòðèö.ïðèáàâêè. Ñ ëàêòÀçîé òàêîé ðåá¸íîé áûñòðî íàáèðàåò âåñ. Äðóãîå äåëî,÷òî èíîãäà ëàêòÀçà íå ðàáîòàåò è áåçëàêòîçíàÿ äèåòà íå óëó÷øàåò ñîñòîÿíèå, òîãäà íóæíî ïðîâîäèòü äèô.äèàãíîñòèêó ñ íàñëåäñòâåí.íàðóøåíèÿìè îáìåíà. ß íåîíàòîëîã è èìåþ äåëî ñ ïåðâè÷íîé ËÍ èëè òðàíçèòîðíîé ó íåäîíîøåííûõ.  ïðàêòèêå ïåäèàòðà âñòðå÷àåòñÿ ïîçäíÿÿ ôîðìà ËÍ è âòîðè÷íûå, âèäèìî ñ íèìè è âîçíèêëè çàòðóäíåíèÿ. |
#3
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Ñïàñèáî çà áûñòðûé îòâåò!
 òåîðèè ýòî ïîíÿòíî. Íî ÿ â èñòî÷íèêàõ ÿ íå íàøåë ïðî âåñ íè÷åãî. Íàïðèìåð, ïðè íàðóøåíèè âñàñûâàíèÿ ãàëàêòîçû - îáåçâîæèâàíèå, äèàðåÿ è âåñ íà ïåðâîì ìåñòå, ïðè ËÍ - îïèñûâàþòñÿ òîëüêî ñèìïòîìû, ñâÿçàííûå ñ äèñêîìôîðòîì |
#4
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Åâãåíèé, ñïàñèáî çà ïîñò, ò.ê.çàñòàâèëè ìîçãè øåâåëèòüñÿ è íà÷àòü ðûòüñÿ â ëèòåðàòóðå, îò÷åãî åù¸ áîëüøå çàïóòàëàñü).
Ñêîëüêî âèäåëà ïåðâè÷íîé ËÍ ó íîâîðîæäåííûõ ãèïîòðîôèÿ ïðèñóòñòâîâàëà îáÿçàòåëüíî. Íó, à ê ÷åìó ïðèâîäèò ðâîòà è ïîíîñ ó ÷åëîâåêà? Òåì áîëåå åñëè ýòî íîâîðîæäåííûé? Âîò,íàïðèìåð [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Äðóãîå äåëî âòîðè÷íàÿ ËÍ, çäåñü íå âñ¸ òàê ïðîñòî. Íàäåþñü, òÿæåëàÿ àðòèëëåðèÿ ïîäêëþ÷èòñÿ è íàñòàâèò íà ïóòü èñòèííûé. |
#5
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÷òî ïèøóò çäåñü (âûäåëåíî ìíîé):
Primary (or true) lactose intolerance This extremely rare genetic condition is incompatible with normal life unless there is medical intervention. A truly lactose-intolerant baby would fail to thrive from birth (ie not even start to gain weight) and show obvious symptoms of malabsorption and dehydration. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] èëè Cow milk protein intolerance (CMPI) affects 3% of infants under the age of 12 months and is often misdiagnosed as GERD or colic, risking dangerous exposure to antigens...Clinical manifestations of CMPI include diarrhea, bloody stools, vomiting, feeding refusal, eczema, atopic dermatitis, urticaria, angioedema, allergic rhinitis, coughing, wheezing, failure to thrive, and anaphylaxis. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] èëè âîò òàêàÿ ïóáëèêàöèÿ ïîëóâåêîâîé äàâíîñòè: West Afr Med J Niger Pract. 1968 Feb;17(1):14-6. Lactose intolerance in infancy as a cuase for failure to thrive. Seriki O, Adcock KJ. êàê ïåðåâîäèòñÿ àíãëèéñêîå failure to thrive (íåäîáîð âåñà/ðîñòà/äð. àíòðîïîìåòðè÷. äàííûõ â êîíêð. ïåðöåíòèëÿõ) ìîæíî ïî÷èòàòü çäåñü [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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åñëè ãîâîðèòü î íåïåðåíîñèìîñòè êîðîâüåãî ìîëîêà ó ãðóäíè÷êîâ, òî çàìåäëåíèå/îòñóòñòâèå íàáîðà âåñà/ðîñòà íà ôîíå äèàðåè/ðâîòû/ïðîáëåì ñ êîðìëåíèåì ïîçâîëÿåò äèàãíîñòèðîâàòü áîëåå òÿæåëóþ ôîðìó íåïåðåíîñèìîñòè (òîãäà êàê ïðè áîëåå ëåãêèõ ôîðìàõ àíàëîãè÷íûå ÆÊÒ ïðîáëåìû ìåíåå âûðàæåíû è íå âëèÿþò íà íàáîð âåñà/ðîñòà) - àëãîðèòìû/ôèãóðû 1 è 2 ïî ññûëêå:
Guidelines for the diagnosis and management of cow's milk protein allergy in infants [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] òàì æå â òàáëèöå Alarm symptoms - Gastrointestinal tract: Failure to thrive due to chronic diarrhoea and/or refusal to feed and/or vomiting
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Âàäèì Âàëåðüåâè÷, çäðàâñòâóéòå!
Ñïàñèáî! Öèòàòà:
Åñëè ýòî ãðóäíè÷îê, êîòîðûé ïèòàåòñÿ òîëüêî ìîëîêîì ìàìû, òî â îòñóòñòâèå ôåðìåíòàè ïðè íàëè÷èè ïîíîñà, ãèïîòðîôèÿ áóäåò, à êàê èíà÷å. Äðóãîå äåëî ïîçäíÿÿ ËÍ, êîãäà ÷åëîâåê ïèòàåòñÿ íå òîëüêî ìîëîêîì |
#8
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çäðàâñòâóéòå, Àíàñòàñèÿ!
Öèòàòà:
Hypolactasia, or lactase deficiency, exists in 3 distinct forms: congenital, primary and secondary. è èìåííî âðîæäåííûé äåôèöèò ïðîÿâëÿåòñÿ íåäîáîðîì âåñà ñ ïåðâûõ ïîïûòîê/äíåé íàêîðìèòü ðåáåíêà: Congenital lactase deficiency is associated with the least lactase activity. It is a lifelong disorder characterized by failure to thrive and infantile diarrhoea from the first exposure to breast milk. Congenital lactase deficiency is extremely rare, with only around 40 cases having been reported. It is a single autosomal recessive disorder, but very little is known about the molecular basis. The only treatment is complete avoidance of lactose from birth. ïðàâäà øàíñû åå âñòðåòèòü â òå÷åíèå ñâîåé êàðüåðû ó êîíêðåòíîãî ïåäèàòðà ñòðåìÿòñÿ ê íóëþ, òàê ÷òî Íåëüñîí èëè äð. ïåäèàòðè÷åñêèå ìàíóàëû ÍÅ âêëþ÷àþò ýòè äàííûå â òåêñò, ïîäðîáíåå 2008 Review article: lactose intolerance in clinical practice – myths and realities [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïóáëèêàöèÿ èç ßïîíèè ñïóñòÿ 4 ãîäà óæå áîëåå äåòàëüíî îïèñûâàåò ãåíåòèêó âðîæäåííîãî îòñóòñòâèÿ ëàêòîçû (MIM 223000), õîòÿ òå æå ñèìïòîìû ñèëüíàÿ äèàðåÿ è ïîòåðÿ âåñà (ïðè ðîæäåíèè 3,100 - ÷åðåç 4 äíÿ 2,700) ïðèñóòñòâóþò: Two novel mutations in the lactase gene in a Japanese infant with congenital lactase deficiency. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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åùå îäèí êåéñ èç Ãåðìàíèè î ðåáåíêå ñ âðîæäåííûì äåôèöèòîì îò áëèçêîðîäñòâåííîãî áðàêà òóðåöêèõ ðîäèòåëåé òîæå ïîâåñòâóåò î ïîòåðå âåñà:
The child was born at term with a weight of 3380 g. He developed 12–15 watery stools per day after breast feeding was started. He was admitted to hospital on postnatal day 17 with a weight loss of 14 % as compared to birth weight. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] î íåïåðåíîñèìîñòè ëàêòîçû ó âçðîñëûõ (èëè äåôèöèòå ëàêòàçû ó âçðîñëûõ) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Öèòàòà:
 ð/ä äåòè èìåëè îòðèöàòåëüíûå ïðèáàâêè, ïîíîñ, ñðûãèâàíèÿ.  îäåëåíèè 2 äíÿ ìû áåçóñïåøíî ïûòàëèñü íàëàäèòü òåõíèêó ÃÂ, áîëüíûå òåðÿëè âåñ, ïîíîñèëè, áûëè âÿëûìè. Ïîñëå ïåðåâîäà íà áåçëàêòàçíóþ ñìåñü ñèòóàöèÿ ñòàëà íàëàæèâàòüñÿ, ïîÿâèëèñü ïîëîæèòåëüíûå ïðèáàâêè, ñòóë íîðìàëèçîâàëñÿ.  ïîñëåäóþùåì ïåðåâåëè íà à+ëàêòàçàð è âûïèñàëè ñ ïîëîæèòåëüíîé äèíàìèêîé ñ çàêëþ÷èòåëüíûì äèàãíîçîì ËÍ. Êàê òî ÿ áûëà óâåðåííà, ÷òî ýòî îíà, óæ áîëüíî ðàçèòåëüíûå ïåðåìåíû ïðîèçîøëè ñ äåòüìè. Õîòÿ ñåé÷àñ, ïðî÷òÿ Öèòàòà:
ê ñîæàëåíèþ, ñâÿçè ñ ýòèìè ïàöèåíòàìè íå ïîääåðæèâàëè. |
#11
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äðóãîå áîëåå ÷àñòîå çàáîëåâàíèå, ÷åì àáñ. äåôèöèò ëàêòîçû, ìîæåò äàâàòü ïîõîæóþ êëèí. êàðòèíó, êîòîðàÿ óëó÷øàåòñÿ íà áåçëàêòîçíîé äèåòå - ãàëàêòîçåìèÿ, âîò êåéñ èç Èòàëèè, ãäå åå ñïóòàëè ñ íåïåðåíîñ. êîðîâüåãî ìîëîêà:
A case of galactosemia misdiagnosed as cow’s milk intolerance [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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Áîëüøîå ñïàñèáî çà ïîìîùü. Çàäàì åùå âîïðîñ: åñëè âåñòè ðå÷ü ïðî âòîðè÷íóþ ËÍ (îíà æå òðàíçèòîðíàÿ, ÿ òàê ïîíÿë), òî ïðè íåé ïîòåðè âåñà íå áóäåò ÷àùå âñåãî. Áóäóò òå æå ïðåñëîâóòûå ÿâëåíèÿ äèñêîìôîðòà è äèàðåè.
Âîò èç ñòàòüè - 2008 Review article: lactose intolerance in clinical practice – myths and realities): There is some evidence that lactase added to products to render them low in lactose or the use of supplemental lactase can help tolerance but this is not always the case. Ýòî æå îòíîñèòñÿ íå ê ïåðâè÷íîé ËÍ è çíà÷èò ìîæíî ðàññìàòðèâàòü èñïîëüçîâàíèå òîãî æå ëàêòàçàðà ó äåòåé ñ òàêèìè ñèìïòîìàìè ïðè äîñòàòî÷íûõ ïðèáàâêàõ? Ïðîñòî ÿ ïðèâûê ïîñëå òîãî, êàê óçíàþ î õîðîøåì âåñå âêëþ÷àòü ÿçûê (óñïîêàèâàòü ðîäèòåëåé) è îòìåòàòü ëþáîå èñïîëüçîâàíèå ëàêòàçû |
#13
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Öèòàòà:
Öèòàòà:
Âîò íåïëîõàÿ ñòàòüÿ íà ðóññêîì [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#14
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Êîå-÷òî è ÿ íàâàÿë íà ýòó òåìó: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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