Nutritional and vitamin status in patients with neuroendocrine neoplasms

Figure 2 Approach to patients with diarrhoea. Summary of causes of diarrhoea in patients with gastroenteropancreatic neuroendocrine neoplasms, how to analyse and treatment advise. ¹Optimise SSA’s: Increase dose, shorten interval or add short acting dose; ²Advise loperamide: Increasing dose 2-4-8 mg 4 times a day, up to 12-24 mg 4 times a day in short bowel syndrome; ³Advise codeine: 15-60 mg 4 times a day; Advise PERT: 1 × 25000 units of lipase per small meal 2 × 25000 units lipase per large meal, titrate up may need > 80000 units per large meal. SSA’s: Somatostatin analogue’s; SeHCAT: Selenium homotaurocholic acid conjugated with taurine; BOD: Twice a day; PERT: Pancreatic enzyme replacement therapy.