N-Acetylcysteine for Gastric Lactobezoars in a 1-Month-Old

Abstract

Gastric lactobezoars are a result of the inability to digest milk and mucous. Formulas that contain high casein concentrations, medium triglyceride oils, or high caloric density can increase the risk of bezoar formation by decreasing gastric secretion or delaying gastric emptying. N-acetylcysteine (NAC) is used to clear thick mucus secretions and is hypothesized to be effective in the treatment of gastric lactobezoars due to the cleavage of disulfide bonds in mucoproteins. We describe the use of NAC in a 1-month-old full term male (4.5 kg) who was diagnosed with a gastric lactobezoar following an upper gastrointestinal series that showed a large persistent filling defect in the distal body, which was suggestive of a gastric lactobezoar. A dose of 45 mg (10 mg/kg) of 10% NAC was diluted in 50 mL of normal saline and given every 6 hours via a nasogastric (NG) tube. Administration was followed by clamping of the NG tube for 2 hours and aspiration of the stomach contents. NAC was discontinued when aspirates were a clear mucus consistency. The patient's gastric lactobezoar was successfully treated with a 10 mg/kg/dose of NAC that was given every 6 hours for a total of 4 doses.

Keywords: NAC; gastric lactobezoar; gastric outlet obstruction/etiology; infant, newborn; n-acetylcysteine; treatment outcome.

Figure.

Radiographic findings confirming gastric lactobezoar. A) Abdomen x-ray showing residual contrast with no free air or pneumatosis. B) Fluoroscopic upper GI with kidney, ureter, and bladder view showing a large persistent filling defect noted in the distal body suggestive of milk bezoar.