Clay Coloured Stools
Dr Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai
Address for Correspondence: Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.
Clinical Problem :
Case: - A 3 month old child presented with clay coloured stools since birth and jaundice with increased sleepiness noticed since past 2 days. On examination, child had jaundice with hepatic encephalopathy, palmar erythema, ascitis, hepatomegaly and petechiae. Other systems were normal. Investigations revealed hyperbilirubinemia {bilirubin = 17.7 mg, dl}, elevated liver transaminases, coagulopathy, hypoalbuminemia and hypoglycemia. Thus child was diagnosed as liver cell failure with encephalopathy and was given treatment for same but died due to a pulmonary hemorrhage.
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Could this child have been diagnosed earlier_?
Discussion :
This child was detected to have clay coloured stools right from birth though jaundice was not picked up. Isolated clay coloured stools without jaundice is rare. The colour of the stools is due to the presence of bile in the stools and thus absence of bile will lead to decolonization of stool. Since the infant is predominantly on milk diet in the 1st few months of life, the colour of stool is white unless bile is present. Absence of bile can occur due to liver disease or obstruction of bile flow. Thus, when there is presence of clay coloured stools, one should always look for jaundice. Neonatal cholestasis is a condition that should be picked up as early in life as possible because delay can lead to irreversible liver damage as seen in this patient. Thus, when one comes to across a child with clay coloured stools, always look at the liver and check for jaundice.
E-published: September 2009, Vol 6 Issue 9 Art No. 50
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