Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Abstract

Protracted diarrhoea in early infancy gives rise to many diagnostic and therapeutic problems. Jejunal biopsy often reveals villous atrophy of varying degrees. Severe reduction of small intestinal absorptive area causes secondary monosaccharide malabsorption, as well as secondary disaccharide deficiency, consequences which are relevant in any attempts at oral feeding. Morphologic, metabolic, endocrinological and microbiological studies have to be undertaken in order to establish a definitive diagnosis in protracted diarrhoea, but these studies often fail to reveal the aetiology of the disease. Immunologic abnormalities like phagocyte dysfunction, thymic atrophy and hypoplasia of B-cell regions in lymph nodes might be secondary events, but some types of immunodeficiency are of primary importance in the development of protracted diarrhoea. Total parenteral nutrition in many cases has to be instituted, with all its implications and hazards: septicaemia is the most dangerous of these. Zinc deficiency and acrodermatitis enteropathica may occur during total parenteral nutrition, and zinc deficiency secondarily contributes to the symptoms of diarrhoea. Parenteral administration of zinc is able to overcome these effects.

Effect of Dietary Nucleotides on Intestinal Repair in Rats with Experimental Chronic Diarrhea

“…Our model can be particularly useful to study the effects of lactose intolerance on the small and large intestine and on the malnutrition status originated by malabsorption of lac-FIG. 2. Effects of dietary nucleotides on maltase, sucrase, and lactase activities (milliunits per centimeter) of ileum in rats with experimental chronic diarrhea induced by ingestion of lactose.…”

Acquired Zinc Deficiency Acrodermatitis Associated with Nephrotic Syndrome

“…In infants and children, acquired zinc deficiency presenting as an acrodermatitis enteropathica‐like dermatitis has been reported as a complication of several systemic diseases, including anorexia nervosa, inflammatory bowel disease, chronic diarrhea, and cystic fibrosis and has also been reported in association with the use of parenteral nutrition in premature infants (6–13). The presumed pathophysiology of acquired zinc deficiency in these conditions is impaired intestinal absorption of zinc or decreased enteral or parenteral zinc intake.…”

Effect of Zinc‐Deficient Diet of Varying Duration on Intestinal Disaccharidase Activity in the Rat

“…The mechanism under-lying the diarrhea is not fully understood. Two case reports have suggested an association between zinc deficiency and carbohydrate malabsorption (8,9). Subsequent research studies demonstrated various results.…”

“…ported significant decreases in water and sodium transport from the small and large intestine of zincdeficient rats compared to corresponding pair-fed controls and to rats fed ad libitum. Some reports have suggested an association between zinc deficiency and carbohydrate malabsorption (8,9). Intestinal disaccharidases are composed of glycoproteins, and hence their synthesis may be affected by zinc deficiency.…”