Dynamic Function test Version: 1

CC SOP Lactose Tolerance Test

Standard Operating Procedure Review date: 14/08/2009
0036 CC0036
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

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LACTOSE TOLERANCE TEST

STANDARD OPERATING PROCEDURE

CC0036

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Page 1 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP Lactose Tolerance Test
Standard Operating Procedure Review date: 14/08/2009
0036 CC0036
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

Lactose tolerance test

Lactose intolerance is the inability to metabolize lactose, a sugar found in milk and other dairy
products, because the required enzyme lactase is absent in the intestinal system or its availability is
lowered. It is estimated that 20% of adult humans are lactose intolerant.

Disaccharides cannot be absorbed through the wall of the small intestine into the bloodstream, so in
the absence of lactase, lactose present in ingested dairy products remains uncleaved and passes
intact into the colon. The resultant in vivo fermentation produces copious amounts of gas which
causes a range of abdominal symptoms, including stomach cramps, bloating, and flatulence. In
addition it causes osmotic diarrhoea.

There are three major types of lactose intolerance:

Primary lactose intolerance. Environmentally induced when weaning a child in non-dairy consuming
societies.

Secondary lactose intolerance. Environmentally induced, resulting from certain gastrointestinal

diseases, including exposure to intestinal parasites such as giardia. In such cases the production of
lactase may be permanently disrupted. A very common cause of temporary lactose intolerance is
gastroenteritis, particularly when the gastroenteritis is caused by rotavirus. Another form of temporary
lactose intolerance is lactose overload in infants.

Congenital lactase deficiency. A genetic disorder which prevents enzymatic production of lactase.
Present at birth, and diagnosed in early infancy.

Principle

In normal individuals lactose will be metabolized to glucose and the plasma glucose level will
increase. Failure to absorb or metabolise lactose will not result in an elevation in blood glucose.

Side effects

This test frequently results in diarrhoea and abdominal pain in affected individuals.

Preparation

Patients must fast for at least 8 hours prior to this test but may drink small volumes of plain water.

Smoking and physical exercise should NOT be allowed in the morning prior to, and during, the test.

Do not photocopy this document

Page 2 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP Lactose Tolerance Test
Standard Operating Procedure Review date: 14/08/2009
0036 CC0036
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

Test procedure

Adults: 50 g lactose in about 200 mL water; drink over 10 minutes.

Children: 1 g lactose per kg body weight up to a maximum of 50 g in about 200 mL water; drink over
10 minutes

Blood specimens are taken pre-test and half hourly for two hours.

Time Test Sample Sample tube Give dose

volume after sample
0 min Glu 2ml Fluoride oxalate (grey top for adults Lactose drink
and yellow for paediatrics) over 10 min
30 min Glu 2ml Fluoride oxalate (grey top for adults
and yellow for paediatrics)
60 min Glu 2ml Fluoride oxalate (grey top for adults
and yellow for paediatrics)
90 min Glu 2ml Fluoride oxalate (grey top for adults
and yellow for paediatrics)
120 min Glu 2ml Fluoride oxalate (grey top for adults
and yellow for paediatrics)

There is no need to take urine samples for glucose measurements.

Interpretation

Plasma glucose should increase by at least 1.0 mmol/L in normal individuals.

Lactose tolerance can also be assessed by measurement of breath hydrogen every half hour for
three hours after the lactose or by the assay of lactase in a small bowel biopsy.

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Last printed: 14 August 2008