Abstract
Clinical features and laboratory tests that determine carbohydrate in faeces were evaluated to determine which was best able to distinguish between osmotic and secretory diarrhoea in infants and children. For this purpose 80 boys aged 3 to 24 months, with acute watery diarrhoea, were studied prospectively. The faecal osmolar gap (FOG) was calculated as: serum osmolarity − [2 × (faecal sodium + potassium concentration)]. Fifty eight patients were classified as having predominantly osmotic diarrhoea (FOG >100 mosmol/l), and 22 as having predominantly secretory diarrhoea (FOG ⩽100 mosmol/l). The two groups were comparable in their clinical features on admission, in the results of blood and urine tests, and in the evolution of their diarrhoeal illness. Evidence of steatorrhoea (by positive Sudan III test) and of acid faecal pH on admission were significantly more frequent in patients with osmotic diarrhoea. Mean (SD) faecal osmolarity was not significantly different between the two groups (319 (80) mosmol/l in secretory diarrhoea v 361 (123) mosmol/l in osmotic diarrhoea). Tests for reducing substances in faeces such as Benedict's test—with and without hydrolysis—and glucose strip, all showed a positive and significant association with osmotic diarrhoea (p <0.05, <0.025, <0.05, respectively). The presence of excess reducing substances (Benedict's test with hydrolysis >++) on admission was the most sensitive and specific test with the best predictive value for differentiating between the two types of watery diarrhoea.
Full Text
The Full Text of this article is available as a PDF (121.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Coello-Ramirez P., Lifshitz F. Enteric microflora and carbohydrate intolerance in infants with diarrhea. Pediatrics. 1972 Feb;49(2):233–242. [PubMed] [Google Scholar]
- Fagundes-Neto U., Viaro T., Lifshitz F. Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance. Am J Clin Nutr. 1985 Feb;41(2):228–234. doi: 10.1093/ajcn/41.2.228. [DOI] [PubMed] [Google Scholar]
- Hammer H. F., Santa Ana C. A., Schiller L. R., Fordtran J. S. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989 Oct;84(4):1056–1062. doi: 10.1172/JCI114267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson D. A., Cattau E. L., Jr Stool chemistries in patients with unexplained diarrhea. Am Fam Physician. 1986 May;33(5):131–134. [PubMed] [Google Scholar]
- Ladefoged K., Schaffalitzky de Muckadell O. B., Jarnum S. Faecal osmolality and electrolyte concentrations in chronic diarrhoea: do they provide diagnostic clues? Scand J Gastroenterol. 1987 Sep;22(7):813–820. doi: 10.3109/00365528708991920. [DOI] [PubMed] [Google Scholar]
- Lifschitz C. H., Irving C. S., Gopalakrishna G. S., Evans K., Nichols B. L. Carbohydrate malabsorption in infants with diarrhea studied with the breath hydrogen test. J Pediatr. 1983 Mar;102(3):371–375. doi: 10.1016/s0022-3476(83)80651-9. [DOI] [PubMed] [Google Scholar]
- Lifshitz F., Coello-Ramirez P., Contreras-Gutierrez M. L. The response of infants to carbohydrate oral loads after recovery from diarrhea. J Pediatr. 1971 Oct;79(4):612–617. doi: 10.1016/s0022-3476(71)80308-6. [DOI] [PubMed] [Google Scholar]
- Lifshitz F., Coello-Ramirez P., Gutierrez-Topete G., Cornado-Cornet M. C. Carbohydrate intolerance in infants with diarrhea. J Pediatr. 1971 Nov;79(5):760–767. doi: 10.1016/s0022-3476(71)80388-8. [DOI] [PubMed] [Google Scholar]
- Maffei H. V., Daher S. R., Moreira F. L. Carbohydrate malabsorption in infants with diarrhea: diagnostic and evolutive aspects. Arq Gastroenterol. 1984 Jul-Sep;21(3):136–142. [PubMed] [Google Scholar]
- Morris A. I., Turnberg L. A. Surreptitious laxative abuse. Gastroenterology. 1979 Oct;77(4 Pt 1):780–786. [PubMed] [Google Scholar]
- Penney M. D., Walters G. Are osmolality measurements clinically useful? Ann Clin Biochem. 1987 Nov;24(Pt 6):566–571. doi: 10.1177/000456328702400603. [DOI] [PubMed] [Google Scholar]
- Read N. W., Krejs G. J., Read M. G., Santa Ana C. A., Morawski S. G., Fordtran J. S. Chronic diarrhea of unknown origin. Gastroenterology. 1980 Feb;78(2):264–271. [PubMed] [Google Scholar]
- Sack D. A., Rhoads M., Molla A., Molla A. M., Wahed M. A. Carbohydrate malabsorption in infants with rotavirus diarrhea. Am J Clin Nutr. 1982 Dec;36(6):1112–1118. doi: 10.1093/ajcn/36.6.1112. [DOI] [PubMed] [Google Scholar]
- Salazar-Lindo E., Sack R. B., Chea-Woo E., Leon-Barua R., Kay B. A., Yi A., Robertson A. D. Bicarbonate versus citrate in oral rehydration therapy in infants with watery diarrhea: a controlled clinical trial. J Pediatr. 1986 Jan;108(1):55–60. doi: 10.1016/s0022-3476(86)80768-5. [DOI] [PubMed] [Google Scholar]
- Shiau Y. F., Feldman G. M., Resnick M. A., Coff P. M. Stool electrolyte and osmolality measurements in the evaluation of diarrheal disorders. Ann Intern Med. 1985 Jun;102(6):773–775. doi: 10.7326/0003-4819-102-6-773. [DOI] [PubMed] [Google Scholar]
- Torres-Pinedo R., Lavastida M., Rivera C. L., Rodrïguez H., Ortiz A. Studies on infant diarrhea. I. A comparison of the effects of milk feeding and intravenous therapy upon the composition and volume of the stool and urine. J Clin Invest. 1966 Apr;45(4):469–480. doi: 10.1172/JCI105361. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson D. R., Ing T. S., Metcalfe-Gibson A., Wrong O. M. In vivo dialysis of faeces as a method of stool analysis. 3. The effect of intestinal antibiotics. Clin Sci. 1968 Feb;34(1):211–221. [PubMed] [Google Scholar]