Osmotic Diarrhea Due to High Sodium Chloride Intake Following Subtotal Resection to the Small Intestine

Abstract

Absorption studies in a 13-year-old boy after subtotal resection of the small bowel revealed, besides the well-known malabsorption of carbohydrates, fat, iron and vitamins, a decreased absorptive capacity for sodium chloride. Following the addition of 256 mM of salt to the daily diet, the stool volume almost doubled, and half the amount of the administered sodium accompanied by high amounts of potassium were excreted in the stools. The loading of control children with sodium chloride resulted in osmotic diuresis, the additional salt being excreted by the kidneys without increasing the enteral water-sodium- and potassium excretion. Since high oral intake of salt may result following subtotal resection of the small intestine in ‘osmotic diarrhea’, the oral salt intake of such patients should not be kept high. Additional salt, if required, should be administered parenterally.

The problems of massive small bowel resection and difficulties encountered in management

“…Until recently, the ideal site for reversal remained a controversial issue. There have been reports that reversal of a segment at the distal end rather than in the proximal part of the remnant gave better results in pigs (Kieninger, 1974) and this has been the experience in dogs (Barros D'Sa, 1975b). A reversed segment in the terminal part of the remnant (Fig.…”

“…When proximal resection is massive, the adequacy of the remaining rate-limited active transport systems in the distal remnant will depend on the solute concentration of its contents. This may result in osmotic diarrhoea (Kerpel-Fronius, Miltenyi and Gorgenyi, 1970). The role of the ileo-caecal valve in preventing malnutrition after massive resection has been emphasized in both experimental and clinical studies (Kremen et al, 1954;Kogan et al, 1957;Chen, 1969).…”

“…The remaining mucosal transport systems become overloaded and a solutetype diarrhoea with substantial fluid and electrolyte loss is produced (Kerpel-Fronius et al, 1970).…”

The Pill, Mesenteric Vein Thrombosis and the Short, Short Bowel Syndrome

“…The massive ablation of bowel meant that only a limited number of active transport sites for absorption were retained and these were located mainly in the distal duodenum. Overloading of residual transport systems understandably produces a solute‐type diarrhoea[25], a significant symptom requiring control. Fortunately, the ileo‐caecal valve was intact and being able to delay transit [26], will have prevented the appreciable deficiencies which might otherwise have occurred.…”