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Interesting case that might attract some comment? A 13 month old baby with chronic diarrhoea Liver profile / Renal profile all normal with the exception of Albumin 33 g/L Stool sample sent to the laboratory with request "Reducing substances please and anything else you can think of?" My first thought was ? Send it to India, but I persevered Reducing substances -VE Fat Microscopy -VE Sample was centrifuged and yielded 5 mls of clear brown liquid with about a gram of solid matter at base of tube. Stool Osmolality 331 mosmol/Kg Na 49 mmol/L K 37 mmol/L Calculated Osmolality 172 Osmolal Gap 159 --> Osmotic diarrhoea ? Epsom Salts being added to milk feed Mg 1.5 mmol/L --> So no Paeds ? Protein losing Enteropathy can you measure a Faecal Alpha 1 Antitrypsin Well S.Albumin was on the low side so why not thought I Stool Alpha 1 Antitrypsin 0.23 g/L (well I have no idea what the normal range is, ? anyone else know) More results were now appearing IgG 5.1 g/L (3.1 - 13.8) IgA <0.05 g/L (0.3 - 1.2) Paeds ? malabsorption IgM 0.3 g/L (0.5 - 2.2) Anti Gliadin IgG abs - POSITIVE Anti Gliadin IgA abs -NEGATIVE Awaiting Endomyseal abs result So ? Coeliac disease. The baby had all gluten removed from diet and switched to Soya feed. Diarrhoea resolves in 4 days The interesting bit of this case for me is the request for a faecal A1AT for ? protein losing enteropathy. Not something I have encountered before. Does anyone have any info on the usefulness of a one off measurements. I found a couple of references on medline that mentioned Stool A1ATclearances but no examples. Cheers John ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/