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Old 09-28-2012
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Question Fluid Loss and Diarrhea

A 44 yr old female has been taken to a physician by her daughter for her evaluation of diarrhea and profuse sweating....she complaints a recent change in her mother's lifestyle..she is unable to remember her regular things like cooking, laundry and sometimes it takes difficulty to recognize some persons well known to her...her past medical histories include a flexural rash a month ago...she is regularly passing 3-5 stools/day..what is the extra diarrheal features this pt. can be seen with ..?

a) excess loss of hypotonic fluid with blood
b) excess loss of hypotonic fluid with stool osmotic gap <50mosm/kg
c) loss of isotonic fluid with stool osm. gap <50mosm/kg
d) loss of isotonic fluid with stool osm. gap >100mosm/kg
e) rice watery stools with excess hypotonic fluid loss
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Old 09-29-2012
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Default Will go with C.

Sounds to me like Carcinoid Syndrome secondarily leading to niacin deficiency. The three classic D's: Dementia (she can't remember things), Diarrhea and the Dermatitis (Flexural rash mentioned in stem). I'm not sure though what diarrhea Carcinoid syndrome would cause, so I will go with C.

Last edited by dockhi; 09-29-2012 at 10:28 AM.
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Old 09-29-2012
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Correct Answer c is right

yes, the correct answer is C) loss of isotonic fluid with stool osm. gap <50mosm/kg

ya from the symptoms-----profuse sweating,diarrhea, dementia,dermatitis(3D's)-----we can know it as pellagra due to niacin deficiency secondarily developed by carcinoid tumor(due to excessive use of niacin in production of serotonin)

diarrhea due to carcinoid is isotonic high volume diarrhea....

diarrhea----- 3 types

1) invasive------low volume diarrheas with invasion(so bloody diarrheas)----ex...shigella,campylobacter,salmonella

high volume diarrheas are 2 types------secretory and osmotic

2) secretory diarrhea-----isotonic loss of fluid with stool osmotic gap <50mosm/kg e.g-----laxatives,carcinoid tumor,enterotoxins

3) osmotic diarrhea-----hypotonic loss of fluid with stool osmotic gap >100mosm/kg e.g----giardia, lactase deficiency
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dockhi (09-29-2012), Janakpriya (09-30-2012), mnos7i (09-29-2012), sruthi (09-30-2012), tai35 (09-30-2012), Wajahat (10-01-2012)



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Electrolytes-, Pathology-, Step-1-Questions, Syndromes-Acronyms

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