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Step 1
Eliminate the carbohydrates from the diet that are malabsorbed. Patients with celiac disease may require a permanent diet that is completely devoid of barley, rye and wheat.
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Step 2
Feed most infants a glucose polymer such as Pregestimil, if possible. Patients with severe carbohydrate intolerance may require a casein-based formula that contains essential amino acids and no carbohydrates such as MJ3232A.
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Step 3
Reintroduce fructose into the diet slowly after the diarrhea has resolved. Begin with a formula of 14 g fructose/L and gradually increase it to 56 g fructose/L in 14 g increments. The fructose is then replaced by Polycose by the same method and finally the Polycose is replaced by Pregestimil. If the symptoms return after several weeks without carbohydrates, the carbohydrate malabsorption is probably caused by a congenital defect.
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Step 4
Treat any resulting diarrhea with a broad spectrum antibiotic to control bacterial overgrowth. Those with good anaerobic coverage such as gentamicin or metronidazole are preferred.
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Step 5
Perform liver, gut or multivisceral transplants in some children with short gut syndrome where the malabsorption syndrome is caused by prolonged parenteral nutrition.
