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Test Code LAB9039 Electrolyte and Osmolality Panel, Feces

Additional Codes

EFPO

Useful For

Workup of cases of chronic diarrhea

 

Diagnosis of factitious diarrhea (where patient adds water to stool to simulate diarrhea)

Profile Information

Test ID Reporting Name Available Separately Always Performed
NA_F Sodium, F No Yes
K_F Potassium, F No Yes
CL_F Chloride, F Yes Yes
OSMOF Osmolality, F Yes Yes
MG_F Magnesium, F Yes Yes
OG_F Osmotic Gap, F No Yes
POU_F Phosphorus, F Yes Yes

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Fecal


Ordering Guidance


This test is only clinically valid if performed on watery specimens. In the event a formed fecal specimen is submitted, the test will not be performed.



Specimen Required


Patient Preparation: No barium, laxatives, or enemas may be used for 96 hours prior to start of, or during, collection.

Supplies: Stool containers-24, 48, 72 Hour Kit (T291) Note: A random collection is required, but may be submitted in containers provided for timed collection.

Container/Tube: Stool container

Specimen Volume: 10 g

Collection Instructions:

1. Collect a very liquid, random stool specimen.

2. Do not add preservative to the specimen. If a preservative is added, testing will be canceled.


Specimen Minimum Volume

5 g

Specimen Stability Information

Specimen Type Temperature Time Special Container
Fecal Frozen (preferred) 14 days
  Refrigerated  7 days
  Ambient  48 hours

Reference Values

An interpretive report will be provided

CPT Code Information

82438-Chloride

83735-Magnesium

84302-Sodium

84100-Phosphorus

84999 x 2-Osmolality, Potassium

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EFPO Electrolyte and Osmolality Panel, F 88697-8

 

Result ID Test Result Name Result LOINC Value
NA_F Sodium, F 15207-4
K_F Potassium, F 15202-5
CL_F Chloride, F 15158-9
MG_F Magnesium, F 29911-5
OG_F Osmotic Gap, F 73571-2
POU_F Phosphorus, F 88713-3
OSMOF Osmolality, F 2693-0

Interpretation

Osmotic Gap:

Osmotic gap is calculated as 290 mOsm/kg-(2[Na]+2[K]). Typically, stool osmolality is similar that seen in serum since the gastrointestinal (GI) tract does not secrete water.(1)

 

An osmotic gap above 50 mOsm/kg is suggestive of an osmotic component contributing to the symptoms of diarrhea.(1,5,7)

 

Magnesium-induced diarrhea should be considered if the osmotic gap is above 75 mOsm/kg and is likely if the magnesium concentration is above110 mg/dL.(1)

 

An osmotic gap of50 mOsm/kg or less is suggestive of secretory causes of diarrhea.(1,5,7)

 

A highly negative osmotic gap or a fecal sodium concentration greater than plasma or serum suggests the possibility of either sodium phosphate or sodium sulfate ingestion by the patient.(4)

 

Phosphorus:

Phosphorus elevation above 102 mg/dL is suggestive of phosphate-induced diarrhea.(4)

 

Osmolality:

Osmolality below 220 mOsm/kg indicates dilution with a hypotonic fluid.(1)

 

Sodium and Potassium:

High sodium and potassium in the absence of an osmotic gap indicate active electrolyte transport in the GI tract that might be induced by agents such as cholera toxin or hypersecretion of vasoactive intestinal peptide.(1)

 

Sodium:

Sodium is typically found at lower concentrations (mean 30 ± 5 mmol/L) in patients with osmotic diarrhea caused by magnesium-containing laxatives, while typically at higher concentrations (mean 104 ± 5 mmol/L) in patients known to be taking secretory laxatives.(8)

 

Chloride:

Chloride may be low (<20 mmol/L) in sodium sulfate-induced diarrhea.(5)

 

Markedly elevated fecal chloride concentration in infants (>60 mmol/L) and adults (>100 mmol/L) is associated with congenital and secondary chloridorrhea.(6)

Method Description

Osmotic Gap:

Calculated result=290 mOsm/kg - 2(stool Na [mmol/L] + stool K [mmol/L])

 

Osmolality:

The depression of the freezing point of serum or other fluid is used to measure osmolality in most osmometers. The extent of lowering below 0° C (the freezing point of water) is a function of the concentration of substances dissolved in the serum. By definition, 1 milliosmole per kilogram lowers the freezing point 0.001858° C.(Schnidler EI, Brown SM, Scott MG: Electrolytes and Blood Gases. In: Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:610-612)

 

Sodium, Potassium, and Chloride:

The Roche cobas c 501 analyzer makes use of the unique properties of certain membrane materials to develop an electrical potential (electromotive force: EMF) for the measurements of ions in solution. The electrode has a selective membrane in contact with both the test solution and internal filling solution. The internal filling solution contains the test ion at a fixed concentration. The membrane EMF is determined by the difference in concentration of the test ion in the test solution and the internal filling solution. The EMF develops according to the Nernst equation for a specific ion in solution.(Package insert: ISE reagent. Roche Diagnostics; V14, 02/2018)

 

Phosphorus:

In the presence of sulfuric acid, inorganic phosphate and ammonium molybdate form an ammonium phosphomolybdate complex. The concentration of phosphomolybdate formed is measured photometrically and is directly proportional to the inorganic phosphate concentration.(Package insert: Phosphorus reagent. Roche Diagnostics; V9.0, 09/2019)

 

Magnesium:

In an alkaline solution, magnesium forms a purple complex with xylidyl blue, a diazonium salt. The magnesium concentration is measured photometrically via the decrease in the xylidyl blue absorbance.(Package insert: Magnesium reagent. Roche Diagnostics; V8.0, 01/2020)

Specimen Retention Time

7 days

Reject Due To

Preservatives added Reject

Method Name

OG_F: Calculation

NA_F, K_F, CL_F: Indirect Ion-Selective Electrode (ISE) Potentiometry

OSMOF: Freezing Point Depression

POU_F: Photometric, Ammonium Molybdate

MG_F: Colorimetric Titration

Forms

If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.

Secondary ID

35091

Day(s) Performed

Monday, Thursday

Report Available

1 to 3 days