CHRONIC DIARRHEA AND ALKALOSIS

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Abstract
Three balance studies were carried out in a patient with severe diarrhea with alkalosis which had its onset in the neonatal period. The patient excreted frequent, profuse, watery stools containing large quantities of chloride, sodium, and potassium. The urine was quite hypotonic. When sufficient amounts of sodium, potassium, and chloride were provided in the diet and the child was not allowed to become dehydrated, body electrolyte and water could be maintained in a physiological range. This did not affect the volume, frequency, or content of the stools. This patient was considered to be similar to the two cases of "congenital alkalosis" with diarrhea originally described by Gamble and Darrow. An investigation of causes of the metabolic abnormality of this patient which had not been previously studied were presented. An exploratory laparotomy failed to demonstrate an anatomical lesion which might explain the patient's basic problem. No abnormal endocrinopathy could be demonstrated. The child did fail to hydrolyze lactose in one out of three lactose tolerance tests. The absence of lactase activity in the duodenum was confirmed by a duodenal biopsy. Since a number of investigators have recently demonstrated a transient lactase deficiency in association with chronic or acute diarrhea, which resolved when the underlying problem was corrected, it was considered quite unlikely that this was the intrinsic defect in this child.

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