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.

Abstract

The generally accepted concept that metabolic acidosis in infant diarrhea results from the loss of buffer base in the stool has been based on the common observation that inorganic cations predominate over inorganic anions in diarrheal stools (1)(2)(3)(4)(5). 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).The effect of fecal loss of organic anion on acidbase balance will depend upon several factors. 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

Influence of Disaccharides on the Development of Systemic Acidosis in the Premature Infant

“…These fecal changes increased progressively to reach a peak and subsequently returned to the initial values, while only 5-10% of the ingested sugar was recovered as total reducing substances in the stools. Similar findings were reported by Torres-Pinedo et al [42]. The result of the large lactose load was acidification of body fluids reflected by a marked drop in blood pH values to a low of 7.22 4-5 hr after the oral load.…”

“…The decreases of both chloride and bicarbonate levels must be accounted for by the accumulation of other anions, presumably organic acids. Indeed, in addition to the development of metabolic acidosis and chloride loss, there was a simultaneous rise in the levels of lactate in blood in all premature infants given lactose, comparable to that seen in children with diarrhea as described by Torres-Pinedo et al [42]. The amount of lactic acid increase over the basal concentrations (A), however, did not account for the reduction in the levels of chloride in serum, for the maximal lactate value was 0.81 mmole/liter or only one-ninth of the anion substitution for chloride.…”

“…The amount of lactic acid increase over the basal concentrations (A), however, did not account for the reduction in the levels of chloride in serum, for the maximal lactate value was 0.81 mmole/liter or only one-ninth of the anion substitution for chloride. Other organic acids with a low pK o such as those produced in patients with diarrhea due to lack of specific disaccharide-splitting enzymes [43] or after milk administration [42] probably account for the anion substitution; however, they were not measured.…”

“…If proximal intestinal absorption of lactose is partially impaired, the resulting large supply of this carbohydrate to the distal segments of the bowel might cause overproduction of lactic acid and other organic acids as a consequence of fermentation by bacterial action [42,43]. In order to study the effects of gut sterilization on the development of systemic acidosis induced by lactose, a group of six infants was studied after treatment with neomycin (Fig.…”

“…Recently, Torres-Pinedo et al [42] showed that the organic acids generated from carbohydrates in the intestinal lumen play an important role in the disturbances of acid-base equilibrium of infants with diarrhea. These acids are absorbed in part and are neutralized in the gut by secretion of large quantities of cations with loss of bicarbonate, thus increasing the H+ ion concentrations of body fluids.…”