Dilutional diarrhoea: under-diagnosed and over-investigated.
We report two cases of factitious diarrhoea caused by stool dilution. In the first report stools from a patient with chronic diarrhoea were found to have been diluted with urine, and the diarrhoea further compounded by surreptitious laxative misuse. In the second report, after prolonged investigation of high output ileostomy, the patient's ileal effluent was found to have been diluted with water. We conclude that factitious diarrhoea, in particular dilutional diarrhoea, is over-investigated and underdiagnosed. Stool weights, complete input/output measurement, analysis of stool osmolality and electrolytes, and laxative screening are essential in the investigation of chronic watery diarrhoea.
Digestive Diseases Research Centre, St Bartholomew's and the Royal London Hospitals School of Medicine and Dentistry, London, UK. r.c.pollok@mds.qmw.ac.uk
R C
RC
Pollok
M R
MR
Banks
P D
PD
Fairclough
M J
MJ
Farthing
D002400:Cathartics / Q000009:adverse effects; D002908:Chronic Disease; D003967:Diarrhea / Q000209:etiology* / Q000523:psychology; D005162:Factitious Disorders / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007081:Ileostomy; D008875:Middle Aged; D019966:Substance-Related Disorders
D002400:Cathartics