Cornstarch Therapy Guidelines

Rationale for use:
Cornstarch is a complex carbohydrate which provides a slowly released source of glucose. It may be used to prevent hypoglycemia during intervals between feedings (especially at night) in infants over age 9 months, children and adults with certain metabolic conditions including fatty acid oxidation disorders, organic acid disorders and glycogen storage disorders.

Dosage:
The dose to use should be discussed with the child’s metabolic physician.
Doses vary from 1.0 –2.5 g/kg/day given before bedtime to provide 6-8 hours of glucose production, depending on the disorder and the degree of severity.
Long chain fatty acid oxidation defects, organic acid disorders: 1.0- 1.5 g/kg /day
Glycogen storage disorders: 1.75-2.5 g/kg/day
One tablespoon of cornstarch weighs 9 grams

To administer:
Use regular cornstarch available in grocery stores, ie Argo brand
Instruct caregivers to give cornstarch before bedtime
Give as raw, uncooked cornstarch.
Do not heat.
Avoid adding to foods that contain citric acid, as the acid breaks down the starch
Mix in liquid or soft foods in a ratio of 1 tablespoon to 2 ounces of fluid or food.
Add cornstarch to foods allowed on diet restriction for metabolic disorder

For fatty acid oxidation disorders:
Water, iced tea, Gatorade, metabolic formula, skim milk or other fluid
Fat free pudding, fat free yogurt

For organic acid disorders
Water, metabolic formula, juice,
Protein-free pudding, low protein porridge

For glycogen storage disorders
Fructose, sucrose, lactose-free beverage such as water, diet soda, soy milk,

Disadvantages:
-Some children experience constipation on cornstarch therapy
-May cause dental caries – proper dental hygiene is needed after dosing
-Reports of cornstarch granules in the urine of children on high doses of cornstarch causing amyluria (Gitzelman, Oral cornstarch therapy: Is persorption harmless? Eur J Peds 1993:152 (7),592