Sodium, Stool

Laboratory assay overview

This panel measures sodium and potassium in liquid stool and provides an estimated osmotic gap. Measurements of electrolytes and osmotic gap in liquid stool help differentiate between secretory and osmotic diarrhea and, thus, guide further evaluation of chronic diarrhea [1,2]. Depending on how the water content of stool is drawn in the intestine lumen, diarrhea can be categorized as secretory or osmotic. Secretory diarrhea is caused by defective electrolyte absorption that leads to increased stool osmolality. Conditions associated with secretory diarrhea include infection, neuroendocrine tumors, congenital chloridorrhea, intestinal resection, and diffuse mucosal disease [1]. Osmotic diarrhea is caused by the osmotic effect of a substance that retains water in the intestine lumen and leads to decreased stool osmolality. Conditions associated with osmotic diarrhea include ingesting poorly absorbed solutes (eg, sorbitol, mannitol, and laxatives containing magnesium) and enzyme dysfunction (eg, lactose intolerance) [2]. Osmotic gap, calculated as the difference between the stool osmolality and twice the sum of the stool sodium and potassium levels, is useful in assessing the contribution of stool electrolytes to osmolality and differentiating between secretory and osmotic diarrhea [1,2]. A theoretical fecal osmolality, approximately the same as plasma osmolality (290 mOsm/kg), is used in the calculation. The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Schiller LR. Pract Res Clin Gastroenterol. 2012;26(5):551-562. 2. Block DR, et al. Body fluids. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.

Laboratory assay overview

This test measures sodium in liquid stool. Measurements of electrolytes and osmotic gap in liquid stool help differentiate between secretory and osmotic diarrhea and, thus, guide further evaluation of chronic diarrhea [1,2]. Diarrhea can be categorized as secretory or osmotic depending on how the water content of stool is drawn in the intestine lumen. Secretory diarrhea is caused by defective electrolyte absorption that increases the stool's electrolyte levels. Conditions associated with secretory diarrhea include infection, neuroendocrine tumors, congenital chloridorrhea, intestinal resection, and diffuse mucosal disease [1]. Osmotic diarrhea is caused by the osmotic effect of a substance that retains water in the intestine lumen and leads to decreased electrolyte levels in the stool. Conditions associated with osmotic diarrhea include ingesting poorly absorbed solutes (eg, sorbitol, mannitol, and laxatives containing magnesium) and enzyme dysfunction (eg, lactose intolerance) [2]. Stool sodium level is often measured in conjunction with stool potassium level to calculate osmotic gap, which is the difference between the stool osmolality and twice the sum of the stool sodium and potassium levels. Osmotic gap is useful in assessing the contribution of stool electrolytes to osmolality and differentiating between secretory and osmotic diarrhea [1,2]. The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Schiller LR. Pract Res Clin Gastroenterol. 2012;26(5):551-562. 2. Block DR, et al. Body fluids. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.