The Effect of Pancreatin on Fat Digestion in an Infant

Abstract

The effectiveness of pancreatin in treatment of pancreatic deficiency has long been a subject of controversy. Recently reported balance studies by Ross 1 and by Harris and co-workers 2 on a total of 23 infants and children indicate that pancreatin is effective in improving fat utilization. Vitamin A absorption studies have also tended to confirm this lipolytic effectiveness of pancreatin.3Additional data regarding the effect of pancreatin on fat digestion are provided by the present study, in which 10 paired balance periods were observed in a single infant with pancreatic exocrine deficiency. The age of the infant was 2 months at the beginning of the experiment. He weighed 4500 gm. at that time and increased to 5400 gm. by the end of the study, at age of 4 months. No family history of pancreatic exocrine disease was known. Pancreatic deficiency was proved by duodenal drainage with use of secretin and double-lumen gastroduodenal tube. One of these tests was performed at the age of 2 months. The volume of fluid aspirated after intravenous injection of secretin was 0.2 ml. in 20 minutes. The fluid was dark yellow and slightly alkaline. The undiluted juice produced no tryptic action on x-ray film in 15 minutes at room temperature. At age of 7 months, the duodenal drainage was repeated. The volume obtained this time was 0.9 ml., and the fluid was alkaline and brown.The trypsin test on x-ray film was again negative. The trypsin concentration, as deter¬ mined by the modified Anson method, was 0.9 (Xl0~4), which is in the range for the extreme degree of pancreatic deficiency in the typical case of cystic fibrosis of the pan¬ creas.* In the normal infant the volume is 1-10 ml. and the trypsin concentration 30-120 ( 10"*). The gastric juice was strongly acidic. The infant had no apparent pulmonary disease, so that confusion of interpretation incident to administration of antibiotics was avoided. There were still no pulmonary symptoms at the time of the later check-up, at age of 7 months. By this time the infant had not been given antibiotics except for two weeks during one respiratory infection, which terminated without residual symptoms. Parotid salivary chloride levels at ages of 2 and 7 months were 99 and 92 mEq. per liter, in comparison with values ranging from 17 to 55 mEq. in nonfibrocystic infants past the newborn period.6 Sweat tests were done at the ages of 2 months and 7 months. The chloride levels of the sweat were 82 and 100 mEq. per liter, respectively, compared with a normal range of 10-70 mEq.7 Ten periods using pancreatin (Viokase powder) were alternated with ten periods using casein (Casec) as a protein control substance. The dosage of pancreatin was 1 gm. with each bottle feeding, five times daily. The feeding consisted essentially of milk, in the form of evaporated milk diluted with an equal part of water, given five times daily. The quantity of milk given was deter¬ mined by the appetite of the infant, but it