Andersen Baby's Tummy Troubles

Thursday, November 7, 2013

More from Dr. Phillips on acid dump (nocturnal acid):

You have a period of acid dump from 2 am till about 7am. That is the period of maximal acid dump at night. So, if the drug is in the bloodstream for a maximum of ~2hrs (remember the absorption occurs after ~1.5hrs so, from the 1.5hr mark forward for ~2 hrs you have coverage for any acid being made. So let's say you time it perfectly and give the dose at 1/2 hr after midnight so that the drug would be in the blood stream at 2 am (it takes 1.5 hrs to get absorbed) Then at 2 am you would have drug present for 2 hrs - till 4am. Then no drug - but body still making loads of acid (nocturnal acid). From 4 am on there would be no protection from acid

The acid pumps (called proton pumps) are in the acid making cells (called parietal cells). They make acid when signaled to do so. They are signaled to make acid after you begin eating (mainly by food or milk which raises the pH in the stomach). After your evening meal they go dormant till approx 2am, then they come on and make a large amt of acid. This is because long ago we did not cook things well (no stoves existed, hardly any fire existed) and the large meal of the day was at night then you went to sleep. During the night your body would make a lot of acid to kill the bacteria you ingested (that is how you lived through the night-in essence). So we still have that 2 am to 7 am acid dump.

The other thing you have to know is a little PPI pharmacology - PPIs can only turn off acid pumps that are already on. So if the pumps are not on (in the resting phase) and you take a PPI (that does not have a buffer) then the PPI will get absorbed and when the PPI gets to the parietal cell it will find no acid pumps that are on and it will not be able to shut off any pumps and the PPI will be removed from the body (just as all drugs are removed from the body) through metabolism and elimination. If you take the PPI in an immediate release form with a buffer, then the buffer will turn on a large quantity of acid pumps and they will all get shut off by the PPI. Then later in the early morning hours when the body tries to make the nighttime acid dump (there will be no acid pumps remaining) - so no acid dump.

See how amazing the body is

from midnight to 3 am for the beginning of nighttime acid dump.

The studies were performed (not by me) but over hundred's of studies who look at the baseline pH (before treatment) and then after treatment. So all this baseline data exists and in the observation of these baseline data. And it was observed (quite obvious) that there was all this nighttime acid.

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What's working for Nora

We figured it out so much quicker with this baby than we ever did with our first two. She is now an incredibly pleasant, and dare I say easy, baby. Here's what's working for Baby Nora:

Gerber Goodstart Soothe formula

KlaireLabs Ther-Biotic infant probiotic, 1/4 tsp in morning bottle (work up to this much - start with 1/8 tsp.

OTC lansoprazole capsules, 10mg 3x's a day, changed to 15mg 2x's a day for convenience (this is trial and error; some babies need the three doses so I'd start with that first)

Rolaids liquid antacid (1-2ml) for flare-ups (which are almost 100% GONE!)

Bassinet placed on an incline (front wheels locked and placed inside my husband's work boots, which were then placed on top of a few large books)

Medication information

H2 blockers (ranitidine, Zantac, Pepcid, Axid) are often used for mild acid reflux. They can be given with food. They are VERY weight sensitive and will need to be increased as your child gets bigger. They have a tendency to stop working altogether after a few weeks. A way to prevent this might be not to use it all the time. If your baby needs constant treatment, I suggest looking into a PPI.

PPIs (omeprazole - Prilosec or Zegerid, lansoprazole - Prevacid, Nexium) are proton pump inhibitors. They are, in my opinion, very safe and effective. In babies they are often prescribed twice a day, because younger children metabolize the medication faster than adults. They are available in capsule, suspension, powder (that you make into a suspension) or solutab (which is meant to dissolve quickly on the tongue). Except in the case of Zegerid, these medications are delayed-release, which means they need to be given on an empty stomach (more than 2 hours after the last bottle, usually, in babies) and then 30-90 minutes need to go by before baby is fed. This allows the drug to be absorbed before the acid pumps are activated by food. The drug essentially temporarily paralyzes some of the pumps and limits acid production. H2 BLOCKERS AND PPI'S NEED TO BE GIVEN 4 HOURS OR MORE APART FROM ONE ANOTHER, IF GIVING BOTH.

Liquid antacids (Mylanta Cherry Supreme - discontinued/recalled since 2010), CVS brand cherry antacid, Rolaids) are effective for occasional flare-ups. Aluminum free is the only kind I will give my children. Rolaids came out with one in the fall of 2013 (right in time for Nora) that is easily procured in the United States at most supermarkets. Liquid antacids can cause loose stools because of the magnesium. They are not meant to be used long-term, only until the H2 blocker and/or PPI start working. They are wonderful for the middle of the night when baby can't settle back down and isn't yet due for another dose of her other medication. LIQUID ANTACIDS SHOULD NOT BE GIVEN WITHIN AN HOUR OF A PPI DOSE. THEY CAN BE GIVEN WITH AN H2 BLOCKER WITHOUT ANY PROBLEMS.

IF YOUR BABY IS STILL HAVING ACID FLARE-UPS, THEIR MEDICATION MOST LIKELY NEEDS TO BE ADJUSTED.

Disclaimer: I am not a medical professional. I make no absolute claims on the veracity of my information, nor do I guarantee that you will see the same results we did. Your mileage may vary.