In addition, medicines and formulas in which fructose/sucrose may not be listed as a primary component need to be avoided examples include syrups, enema solutions, some immunoglobulin solutions, and many infant and pediatric nutritional drinks.Īlthough vaccinations are generally safe in children with HFI, the two potentially harmful vaccines are the sucrose-containing rotavirus vaccines, Rotarix ® pre-established oral suspension and RotaTeq ®, the only rotavirus vaccines approved for use in the US. Once the diagnosis of HFI has been made, periodic evaluation of liver function, renal function, and growth is reasonable, particularly if compliance with the fructose/sucrose/sorbitol/sucralose-restricted diet is not absolute.Īgents/circumstances to avoid: Enteral or parenteral exposure to fructose, sorbitol, sucrose, sucralose, and polysorbate, including fructose, fructose-containing oligosaccharides, high-fructose corn syrup, honey, agave syrup, inverted sugar, maple-flavored syrup, molasses, palm or coconut sugar, and sorghum. Surveillance: No formal guidelines for surveillance exist. Given that reduced fruit and vegetable intake is a dietary requirement, daily supplementation with a "sugar-free" multivitamin is recommended to prevent micronutrient deficiencies, specifically water-soluble vitamins. During hospitalizations, special caution is advised to avoid use of fructose-containing intravenous fluids, as well as fructose-containing infant formulas and pharmaceuticals. Prevention of primary manifestations: Dietary restriction of fructose, sucrose, sucralose, and sorbitol is the cornerstone of HFI treatment. Treatment of manifestations: Acute manifestations (e.g., lethargy, seizures, or progressive coma and/or renal and hepatic failure) should be managed symptomatically in a hospital setting, including administration of intravenous glucose (dextrose), supportive treatment of hepatic and/or renal insufficiency, and treatment of metabolic acidosis, if present.
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