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Stool Composition in Factitial Diarrhea: A 6-Year Experience with Stool Analysis

Sidney Phillips; Leigh Donaldson; Kathy Geisler; Angelo Pera; and Rakesh Kochar
[+] Article and Author Information

From the Mayo Clinic and the Mayo Foundation, Rochester, Minnesota. Requests for Reprints: Sidney F. Phillips, MD, Gastroenterology Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Grant Support: In part by grant DK32121 from the United States Public Health Service, National Institutes of Health.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(2):97-100. doi:10.7326/0003-4819-123-2-199507150-00003
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Objective: To evaluate the utility of stool water analysis in the management of patients with chronic diarrhea.

Design: Retrospective analysis of 6 years of experience.

Setting: A specialized laboratory in a major referral center.

Patients: 325 patients with diarrhea who were referred for stool chemistry analysis. Fecal analysis was requested by many internists and gastroenterologists. Patient records were reviewed to establish the final and most likely cause of diarrhea.

Results: One third of patients provided samples that were inappropriate for analysis, but data from 202 persons were available. The usefulness of the general separation of cases of chronic diarrhea into those in which patients had predominantly osmotic pathophysiologies and those in which patients had predominantly secretory pathophysiologies was confirmed, but overlap and intra-individual variability limited the usefulness of this approach in individual patients. Thirty-five patients (17%) had a diagnosis of factitial diarrhea (30 because of laxative use and 5 because of fluid added to stools).

Conclusions: Among selected subpopulations, the chemical analysis of fresh stools has a role in the evaluation of obscure examples of chronic diarrhea. It is especially useful in identifying factitial diarrhea.

Figures

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Figure 1.
The osmotic gap of stool water for subgroups of patients with diarrhea.Table 1dotted lines

The osmotic gap is derived from the following formula: 290 − (2[sodium concentration + potassium concentration]). Patients with negative values were not included, nor were the patients with miscellaneous diagnoses. All patients with fecal fat excretion of more than 7 g/d were included, regardless of whether an underlying diagnosis was established (see ). Values for osmotic gaps between 50 and 100 mOsm/kg ( ) represent a “gray zone” between low (secretory diarrhea) and high (osmotic diarrhea) gaps. Micro/Collag = microscopic and collagenous.

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Figure 2.
The pH of stool water for subgroups of patients with diarrhea.Table 1dotted lines[15]

The group with miscellaneous diagnoses was not included. All patients with fecal fat excretion of more than 7 g/d were included, regardless of whether an underlying diagnosis was established (see ). Values for pH between 5.0 and 6.0 ( ) are similar to those reported for experimental carbohydrate malabsorption diarrhea . Micro/Collag = microscopic and collagenous.

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