TRANSIENT MONOSACCHARIDE INTOLERANCE IN A NEWBORN INFANT

Abstract

A newborn infant with transient monosaccharide intolerance of noninfectious origin is described. During the first day of life the patient suffered severe anoxia with several episodes of prolonged apnea and cyanosis. On the second day of life she was fed 5% glucose and water and severe diarrhea ensued. After oral feedings were stopped the diarrhea ceased. On the third and fourth day of life similar episodes of diarrhea induced by glucose and water feedings occurred. The stools were acid and contained carbohydrates. However, when the patient was fed sterile water or a carbohydrate free diet, the diarrhea improved. The stools remained normal with fecal pH of 7.0 and no carbohydrates present as long as she was given no carbohydrates by mouth during the first 22 days of life. The intolerance to oral glucose extended to other monosaccharides like fructose and D-xylose. However, after being free of diarrhea for 16 days she began tolerating increasing quantities of glucose in the diet. The capacity to tolerate fructose and xylose was also recovered at 40 and 42 days of life. Disaccharide intake was begun the 44th day of life. She was fed dextrimaltose as a source of carbohydrate in the diet with good results. Sucrose was not tolerated on the 67th day of life. Severe diarrhea, dehydration, and metabolic acidosis ensued after "sugar and water" was fed. However, this disaccharide was well tolerated by 150 days of life. Lactose was not tolerated on the 81st day of life. Milk formula feedings induced diarrhea with stools being acid and containing large quantities of carbohydrates. However, all dietary carbohydrates were tolerated by 180 days of life, lactose was fed with good results. The patient had no infection of the upper segments of the small intestine demonstrable to account for the monosaccharide and disaccharide malabsorption. It is tempting to speculate that anoxia in the newborn period might have played a role in the intolerance to carbohydrates seen in this patient during the first six months of life.