The watery diarrhea syndrome

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The watery diarrhea syndrome (WDS) has generated much discussion, many isolated case reports, and considerable confusion in the pathogenesis, evaluation, and treatment of these patients.

It is likely that reported cases have emphasized the infrequency of WDS, the spectacular if not massive diarrhea (often from 6 to 8 liters/24 hr), and relief of symptoms after surgical treatment.

We, too, were impressed after successful treatment of two patients with WDS.1 Our recent experience indicates WDS may be more common than has been thought; that one or more peptides alone or in combination may be responsible for WDS; that elevated levels of peptides may coexist with functional and nonfunctional tumors; and that operations should be limited when tumors or hyperplasia are not found.

Case reports

Case 1. A 51-year-old woman had a 6-month history of 10 to 12 tea-colored stools daily, muscle weakness, and an 11.25-kg (25 pounds) weight loss. The medical history was negative for similar illnesses. Physical examination revealed a thin, weak woman. Vital signs were normal. Laboratory and roentgenographic findings included hypokalemia (potassium level, 2.4 mEq/dl); an abnormal glucose tolerance test; and Giardia lamblia in the stool specimen. Complete barium studies of the gastrointestinal tract were normal. Despite 3 months of metronidazole treatment, the diarrhea did not improve and the serum potassium level ranged between 2.1 and 2.4 mEq/dl. A 24-hour stool specimen revealed 72 mEq/liter of potassium and no pathogenic bacteria. A pancreatic tumor was suspected and a celiac and superior mesenteric arteriogram was done and was normal. . . .



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