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Decreased stool osmolar gap
21%
67/319
Decreased stool pH
61%
195/319
Positive fecal smear for leukocytes
7%
22/319
Positive stool culture for Rotavirus
3%
10/319
Positive stool culture for T. whippelii
5%
16/319
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The patient described in the question stem is most likely suffering from post-infectious lactose intolerance (lactase deficiency). Lactase deficiency can result in decreased stool pH, especially during a lactose challenge. Lactose intolerance is the inability to digest significant amounts of lactose (found in milk products) because of an inadequate amount of the enzyme lactase. Without lactase, undigested lactose accumulates in the gut lumen and allows the gut bacteria to ferment the excess lactose, producing hydrogen that causes bloating and a lower stool pH. Congenital lactase deficiency is extremely common and occurs in in up to 15 percent of persons of northern European descent, up to 80 percent of blacks and Latinos, and up to 100 percent of American Indians and Asians. Incorrect Answers: Answer 1: Lactase deficiency results in an increased stool osmolar gap, as do all forms of osmotic diarrhea. Answer 3: Lactase deficiency is not an infection, and a fecal smear would be negative for leukocytes. Answer 4: Rotavirus can cause diarrhea, but is not the likely cause of this presentation. Furthermore, as a virus, it will not grow as part of a stool culture. Answer 5: T. whippelii is the cause of Whipple's disease, which presents with steatorrhea and fever.
4.5
(8)
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