Stool losses and acidosis in infant diarrhea

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.

“…This predominant loss of inorganic cations has been taken as evidence of loss of bicarbonate. On the other hand, Teree, Mirabal-Font, Ortiz, and Wallace (6) have shown by direct measurements that the pH of the stool water in infant diarrhea is frequently acidic (almost always below the pH of the blood) and that HCO3-is very low or absent. On the basis of the observed differences between Na+ + Ki and Cl-, these authors have suggested that there is a high concentration of organic anions in diarrheal stools of infants and have advanced several hypotheses to explain the origin of these substances (7).…”

“…These include the origin of the organic anions (i.e., whether ingested preformed, or generated within the body) and the nature of, the cations accompanying them (8). Those organic acids generated in the intestinal lumen or elsewhere in the body change the H+ concentration of the body fluids, depending upon the degree of ionization of the acids (6) and the nature of the cations (organic or inorganic) neutralizing the dissociated acids in the stool. Loss of organic anions formed within the body in excess of organic cations isolates He in the body fluids.…”

Metabolic Acidosis due to Inapparent Defects in Renal Acid Excretion in a Patient with Chronic Diarrhea

“…In patients with renal insuffi ciency, net acid excretion at a given glomerular filtration rate is quite variable, whether it is measured in conjunc tion with ordinary dietary intake or with the ingestion of ammonium chloride [11,15,[17][18][19], In our patient, intestinal losses of alkali were tanta mount to an excessive acid burden. Our evaluation of fecal supernatant revealed a substantial sugar content, a large 'anion gap' [1,6] and supraphysiologic osmolality. Unabsorbed sugars were apparently reaching the colon, where bacteria degraded them anaerobically into small organic acids [20,21].…”

“…Those not absorbed from the colon titrated secreted bicarbonate, and their salts en gendered osmotic diarrhea. Excretion of residual anions produced a net loss of alkali [ 1 ].…”

“…Although metabolic acidosis often accompanies diar rhea, the reasons are probably more complex than is gen erally recognized [1][2][3][4]. In young children with diarrhea, Teree et al [ 1 ] found that fecal losses of alkali were mod est in comparison with the normal renal reserve for bicarbonate generation; consequently, the authors sug gested that acidosis had resulted primarily from renal dysfunction, which they attributed to volume contrac tion.…”