Composition of the intestinal fluid and the functional jejunoileal junction in secretory diarrhea of cholera in children.

The study critically evaluates the changes in the chemical composition of the luminal fluid along the whole length of the small intestine in four children with acute cholera and in one with acute noncholeraic diarrhea. In the children with cholera the total CO2 content rose abruptly from a mean of 7.1 mEq/l to 19.6 mEq/l at about two thirds the tube distance from the ligament of Trietz to the end of the ileum and increased further distally. At around the same point the pH also rose and the chloride fell. It is proposed that this level of the small intestine where a sharp transition in total CO2 content occurs be regarded as the functional jejunoileal junction. Sodium and potassium levels were similar in the jejunum and the ileum and the measured osmolality could be accounted for by them. The child with noncholera diarrhea had a very different small intestinal composition i.e. the total CO2 and pH as well as the sodium level remained low while the measured osmolality was high, indicating a high osmotic gap. The presence of a large amount of organic acid anions of bacterial origin and carbohydrate breakdown products may fully explain the findings in this child. More studies, however, are needed on children with noncholera diarrhea to confirm these findings.