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 DEFINITION
The best way of feeding a newborn baby or nursing is to administer the milk of the proper mother. The milk is the basic food in the feeding of the young mammals from the beginning of the history; a finished food is a nutritivamente, and sufficiently to cover all the needs until the first 4-6 months of the life. It contains proteins, fats, carbohydrates, vitamins and microelements.
The lactose is the nico carbohydrate that exists in the milk of our species, it is formed by a glucose molecule and other one of galactosa, and is produced exclusively by the mammary gland.
In the normal digestion, the different azcares - lactose, saccharose, maltosas - suffer a hidrólisis in the microfluffinesses of the intestinal mucous membrane: for action of different enzymes (lactasas), they are unfolded in monosaccharides, or azcares simple, so that they could be absorbed by the intestine.
In some occasions, the lactose is responsible for disorders in children who are unable to unfold the lactose molecule in 2 monosaccharides (glucose, galactosa) in the intestinal light, and to obtain his correct absorption.
It is necessary to differentiate 3 basic concepts:
Reduction of the normal activity of lactasa in the intestinal mucous membrane, already is temporary or permanent.
MALABSORCION OF LACTOSE: Lactasa deficit without clinical intolerance symptomatology, for defect in the unfolding of the lactose that his absorption prevents.
INTOLERANCE TO THE LACTOSE: Complex of symptoms caused by the shortcoming of lactasa
DEFICIT OF LACTOSE
The lactasa deficit (a defect or decrease of the enzyme lactasa entrusted of the digestion of the azcares) is the most frequent cause of malabsorción of carbohydrates. It can owe to several causes:
1) Congenital
2) It would help to an intestinal aggression
- Viral (rotavirus...)
- Bacterial
- Parasitic (Giardias)
- Intolerance to the gluten, bovine proteins, soya, rice and other macromolecules
- Immunodeficiencies (deficit of IgA secretora)
- Alteration of the intestinal motilidad (diarrheas...)
- Other causes: malnutrition, for antibiotics, resections quirrgicas, etc.
The lactose malabsorción produces diarrhea for the presence of carbohydrates not absorbed in the intestinal light, which increase the osmolaridad inside the intestine. This increase of the osmolaridad alters the water secretion and electrolytes in the small intestine and the intestinal peristaltismo stimulates what produces diarrhea.
The lactose malabsorción can go so far as to produce dehydration, metabolic acidosis and undernourishment.
Part of the lactose not absorbed in the small intestine suffers a hidrólisis for the bacteria of the intestine and there produces to itself lactic acid and gases (H2, CO and methane) that are the persons in charge of the flatulence and the meteorismo.
CLINIC OF THE INTOLERANCE TO THE LACTOSE
The clinical picture consists of a watery diarrhea, with acidic dregs that produce annoyance and injuries about the year of the child. In the nursing ones and young children the diarrhea can drive to a dehydration and important affectation of the curve pondo-estatural. Also they accompany themselves of abdominal distension, flatulence and pain of colic type (twisting).
DIAGNOSIS
- Dregs analysis: pH acid and Bodies differentials
- Urine analysis: To discard urinal infection
- Blood test: scoreboards of intestinal malabsorción (red series, sideremia, ferritina, cholesterol, triglicéridos, Ac-antigliadina IgA-IgG, Ac-antiendomisio IgA-IgG)
- Test of exhaled Hydrogen. It measures the hydrogen quantity in the exhaled air, resultant from the bacterial fermentation in the lactose colon badly absorbed.
- Disacaridasas (lactasa) in intestinal mucous membrane.
TREATMENT
It will consist of treating the cause that produces the intestinal injury and withdrawing the lactose of the diet for a variable period of 4-8 weeks like minimal, since in some occasions it can be necessary to continue a diet exempt from lactose up to 6 months. To this end several formulae exist on the market without lactose. Also it is necessary to eliminate different food that contain lactose in small quantities and they might contribute to the absence of success in our dietetic conduct.
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DEFINITION 
