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Exocrine Pancreatic Insufficiency

Updated : September 3, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

pancrelipase 

Start with 500 lipase units/kg Orally per meal and titrate up to 2500 units/kg/meal depending on response; do not exceed 10,000 lipase units/kg daily or less than 4000 lipase units/gms fat intake daily.
Take Snacks along with 50% of the meal dosage.
High-dose Creon: For chronic pancreatitis and pancreatectomy, adults got a dosage of 72,000 lipase units/meal, whereas consuming a minimum of 100 g of fat daily in one clinical trial mentioned in prescribing information; lower starting dosages (i.e., 500 lipase units/kg daily) are consistent along with the Cystic Fibrosis guidelines.
Viokace
Start with 500 lipase units/kg Orally per meal and titrate up to 2500 units/kg/meal depending on response; do not exceed 10,000 lipase units/kg daily or less than 4000 lipase units/gms fat intake daily.
take Snacks along with 50% of the meal dosage.
Viokace should be taken with a Proton pump inhibitors



 

pancrelipase 

Creon/Zenpep
below 12 months: 3,000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 3 years: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
above 4 years: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Pancreaze
Below 12 months: 2000 to 4000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 3 years: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
above 4 years: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Should not exceed 10,000-unit lipase/kg daily or less than 4,000 lipase units/gms fat consumed daily.
Pertzye
Below 12 months: 4000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 4 years and weight above 8 kg: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Above 4 years and weight above 16 kg: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Ultresa
1to 4 years and weight above 14 kg: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Above 4 years and weight above 28 kg: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Viokace
Safety & effectiveness were not established
Recommendations from Consensus Report of Cystic Fibrosis Foundation
Infants below 2 years is 2000 to 5000 lipase units per 120 mL feeding; as the infant grows, adjust the dose should not exceed 2500 lipase units/kg while feeding (or 10,000 lipase units/kg daily)
In general, daily requirement dose is 500-4000 lipase units/gms of fat are necessary



 

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References

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Exocrine Pancreatic Insufficiency

Updated : September 3, 2022




pancrelipase 

Start with 500 lipase units/kg Orally per meal and titrate up to 2500 units/kg/meal depending on response; do not exceed 10,000 lipase units/kg daily or less than 4000 lipase units/gms fat intake daily.
Take Snacks along with 50% of the meal dosage.
High-dose Creon: For chronic pancreatitis and pancreatectomy, adults got a dosage of 72,000 lipase units/meal, whereas consuming a minimum of 100 g of fat daily in one clinical trial mentioned in prescribing information; lower starting dosages (i.e., 500 lipase units/kg daily) are consistent along with the Cystic Fibrosis guidelines.
Viokace
Start with 500 lipase units/kg Orally per meal and titrate up to 2500 units/kg/meal depending on response; do not exceed 10,000 lipase units/kg daily or less than 4000 lipase units/gms fat intake daily.
take Snacks along with 50% of the meal dosage.
Viokace should be taken with a Proton pump inhibitors



pancrelipase 

Creon/Zenpep
below 12 months: 3,000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 3 years: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
above 4 years: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Pancreaze
Below 12 months: 2000 to 4000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 3 years: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
above 4 years: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Should not exceed 10,000-unit lipase/kg daily or less than 4,000 lipase units/gms fat consumed daily.
Pertzye
Below 12 months: 4000 lipase units/kg per 120 mL of formula/breast feeding; given before feeding; capsule ingredients should not be combined directly with formula or breast milk.
1 to 4 years and weight above 8 kg: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Above 4 years and weight above 16 kg: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Ultresa
1to 4 years and weight above 14 kg: Start with 1,000 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2,500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Above 4 years and weight above 28 kg: Start with 500 lipase units/kg/meal; should not exceed 10,000 lipase units/kg daily (2500 lipase units/kg/meal) or less than 4000 lipases units/gms fat consumed daily.
Viokace
Safety & effectiveness were not established
Recommendations from Consensus Report of Cystic Fibrosis Foundation
Infants below 2 years is 2000 to 5000 lipase units per 120 mL feeding; as the infant grows, adjust the dose should not exceed 2500 lipase units/kg while feeding (or 10,000 lipase units/kg daily)
In general, daily requirement dose is 500-4000 lipase units/gms of fat are necessary



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