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Old 08-24-2012
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Question Symptoms after having dairy products

XYZ is a 22 year engineering student,during the past 6 months she experienced several bouts of severe abdominal bloating and cramps followed by diarrhea. At first she thought the symptoms were because of academic stress. However she noticed that the symptoms occurred approximately 1 hour after she drank milk.
She was examined by her primary physician who found her to be in excellent health. For milk related symptoms the physician ordered a Lactose-H2 breath test which confirmed she had lactose intolerance. Her fecal osmolar gap was measured and was elevated. As further confirmation of the dx, She abstained from dairy products for one week and had no episodes of bloating, cramping or diarrhea.

Q1) Why did her Lactose intolerance cause diarrhea?
Q2) Her Lactose-H2 breath test (which involves measuring Hydrogen gas in the breath after ingesting 50g Lactose) was positive. Why?
Q3) Why was her fecal osmolar gap elevated?
Q4) What is the treatment you'll give if she doesn't want to eliminate dairy products from her diet?
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Old 08-24-2012
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...pt. is suffering from lactose intolerance from lactase deficiency....
1)..as food(containing lactose) enters duodenum it is absorbed in normal individuals, as she has lactase deficiency..lactose cannot absorb directly so it enters colon..bacteria in colon ferments lactose and produce methane /co2 gas producing osmotic pressure leading to osmotic diarrhea
2)lactose-h2 breath test----ingestion of lactose metabolizes and produce h2 (also methane)gas by bacteria...also can be smell in breath by detector..
3)in osmotic diarrhea..stool osmotic gap elevated >100 mosm/--.stool ph decreases due to loss of H+ in stool

4) as for this question...i'm not sure...but if available i would give her artificial lactase...
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Old 08-24-2012
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Originally Posted by venky2600 View Post

4) as for this question...i'm not sure...but if available i would give her artificial lactase...
Yes in case the patient doesn't want to abstain from dairy products in his/her diet they will be given lactase tablets which will substitute for the missing brush border enzyme.
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