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Osmotic diarrhea is caused by the presence in the lumen of poorly absorbed, osmotically active solutes. Because water movement is passive, governed by osmotic gradient across mu-cosal membranes, water content in the lumen is increased. Some causes of osmotic diarrhea are presented in the following Table(Table 3 and Table 4). There are two important clinical features of osmotic diarrhea: First, diarrhea stops when pa-tients fast (thus avoiding both malabsorption of nutrients and the ingestion of poorly absorbed solutes). Second, stool analy-sis shows the presence of an osmotic gap; the product 2 (Na + + K+ )(to account for the anions) is less than 290 mmol/L/kg, which is the normal osmolality of secreted fecal fluid. The os-
TABLE 3 Some Causes of Secretory Diarrhea
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Infections Bacterial toxins (enterotoxigenic Escherichia coil) Stimulant Laxatives Ricinoleic acid (castor oil), senna (Senekot), bisacodyl (Dulcolax) Bile Acid and Fatty Acid Malabsorption Intestinal Resection Neuroendocrine Tumors Zollinger-Ellison syndrome (gastrin) Carcinoid syndrome (serotonin, substance P, prostaglandins) Medullary carcinoma of the thyroid (calcitonin, prostaglandins) |
TABLE 4 Some Causes of Osmotic Diarrhea
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Laxatives Containing Poort[y Absorbed Anion Sodium phosphate (Phospho-soda) Laxatives Containing Poortly Absorbed Cation Magnesium hydroxide (Philips Milk of Magnesia), magnesium citrate (Citrate of Magnesia) Disaccharidase Deficiency Lactose intolerance Poorly Absorbed Carbohydrate Lactulose, sorbitol ("sugar free" gum), mannitol, congenital glucose-galactose or fructose malabsorption General Malabsorption Syndromes |
