Measuring Responses to Treatment of
Malabsorption
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Disclaimer
This pocket guide should not be considered exclusive of other methods of care reasonably directed at
obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must
be made by the clinician after consideration of each individual patient situation.
• Monitor the patient for a reversal of the signs and symptoms that caused
the clinician to consider fat malabsorption in the patient:
Signs that patients are responding to therapy
• Nutrition:
▶ Weight goals are achieved.
▶ Refeeding syndrome may appear if the patient is now able to absorb nutrients.
▶ Fat-soluble vitamin deficiencies are improved or resolved (if fat-soluble vitamins
were provided in adequate amounts).
› Serum vitamin A and vitamin D are negative acute phase reactants and should
not be drawn in the setting of inflammatory process or infection.
▶ Hyperglycemia presents itself now that EN absorption is improved in patient with
diabetes. Unrecognized diabetes may become apparent and patients with a history
of diabetes may require escalation of their diabetes regimen.
• Gastrointestinal:
▶ GI symptoms are improved or resolved: diarrhea, gas, bloating, cramping,
abdominal distension, fecal urgency, foul smelling stools, steatorrhea, etc.
Considerations if patients are not responding to therapy
• Failure to gain weight
▶ Enteral formula considerations
• No resolution to GI symptoms
▶ Recheck fecal fat excretion
▶ Reconsider initial diagnosis and evaluate other potential causes of GI symptoms
› Is the patient actually receiving
the prescribed enteral volume
(calories)?
› Is the enteral calorie prescription
adequate for the patient?
› Is the patient adequately hydrated?
› Is good glycemic control achieved?
› Should type or delivery of PERT be
altered?
› Is PERT supplementation adequate?
› Does the patient need acid suppression
to maximize PERT therapy?
› Is the patient compliant with all
therapies?
