Xylose Tolerance Test (Fasting + One-hour Blood + Five-hour Urine−Pediatric)

CPT: 84620
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Test Details

Synonyms

  • d-Xylose Tolerance Test

Test Includes

Fasting plasma xylose, one-hour (child) postdose plasma xylose, plus five-hour urine xylose

Use

Evaluate possible enterogenous malabsorption syndromes; test for functional integrity of the jejunum

Limitations

This test was developed, and its performance characteristics determined, by LabCorp. It has not been cleared or approved by the Food and Drug Administration.

Methodology

Spectrophotometry

Reference Interval

• Plasma: One hour: children: >30 mg/dL

• Urine: Children: 16% to 33% of ingested dose

Additional Information

Xylose is a pentose found naturally occurring in certain fruits such as plums. It is not normally found in significant concentrations in blood or urine thereby rendering the duodenojejunal absorption of d-xylose a useful mechanism to assess the integrity of the gastrointestinal mucosa.

D-xylose is passively absorbed by the small bowel with some 30% to 40% of the ingested dose rapidly excreted in the urine. Absorption into the blood is evaluated at specific time intervals with intestinal malabsorption being indicated by low absorption values. Low values would likewise be seen in celiac diseases, tropical sprue, Crohn's disease, immunoglobulin deficiency, pellagra, ascariasis, blind loop syndrome, radiation enteritis, surgical bowel resection, vomiting, delayed gastric emptying, inadequate hydration, decreased circulation, intrinsic renal disease, thyroid disease, ascites, and increased intestinal motility from any cause. The d-xylose absorption test may be of some help in distinguishing pancreatic insufficiency from jejunal malabsorption. Essentially normal d-xylose absorption values will be obtained in malabsorption values due to pancreatic insufficiency, whereas low blood values will be obtained in jejunal malabsorption.

Urine values for xylose excretion are useful in determining renal insufficiency. Diminished excretion of d-xylose could be indicative of renal insufficiency, thereby invalidating the blood xylose absorption results. Low urine xylose values could also be attributed to incomplete collection or urinary retention.

Specimen Requirements

Specimen

Plasma and urine

Volume

2 mL plasma (each specimen) and 10 mL aliquot of five-hour urine

Minimum Volume

0.6 mL plasma (each specimen) and 0.5 mL aliquot of five-hour urine

Container

Gray-top (sodium fluoride) tube and plastic urine container

Patient Preparation

Patient must fast a minimum of eight hours prior to administration of d-xylose (LabCorp N° 26599, containing 25 g d-xylose). Pediatric patients (younger than nine years) must be fasting for at least four hours. Patient must remain in supine position for duration of test except during urine collection. No food is permitted during the test. Patient should refrain from eating foods containing pentose and medications (especially aspirin, neomycin, colchicine, indomethacin, or atropine) for 24 hours prior to the test. Foods containing pentose include fruits, jams, jellies, and pastries. No water restriction; in fact, patient should be encouraged to drink during the fasting period and during test. Start test in the AM. Instruct patient to void completely. Discard this urine. Draw fasting blood specimen. Weight-based dosage of d-xylose for oral administration: 0.5 g/kg body weight up to a maximum of 25 g. Dissolved in water 10% (w/v) with a maximum of 250 mL. Have patient drink entire amount. Fill cup with 250 mL water and have patient drink this also. Have patient drink another cup with 250 mL water after one hour. Collect urine for five hours after administration of d-xylose. Record total five-hour urine volume and send aliquot. Record total on the request form. Draw remaining blood specimens (children: one hour).

Collection

Pediatric:

Plasma: Draw fasting and one-hour postdose blood samples (See Patient Preparation). Centrifuge and separate plasma from cells immediately. Indicate time drawn (ie, "fasting", "one-hour") on each plasma tube.

Urine: Collect entire five-hour urine volume. Send aliquot.

Storage Instructions

Refrigerate plasma. Maintain urine specimen at room temperature. Urine sample is stable for 14 days at room temperature, refrigerated, or frozen. It is stable for two freeze/thaw cycles.

Causes for Rejection

Plasma specimen not kept chilled; patient vomits test meal; loss of part of urine specimen and/or contaminated with stool

Clinical Information

Special Instructions

Record five-hour urine total volume on the request form.

Aftercare

May cause mild diarrhea

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
293811 Xylose Tol 1-Hr/Pediatric/Ur 016238 Xylose - Fasting mg/dL 10872-0
293811 Xylose Tol 1-Hr/Pediatric/Ur 016626 Xylose - 1 hour mg/dL 23940-0
293811 Xylose Tol 1-Hr/Pediatric/Ur 003510 Xylose, Urine, g/L g/L 3135-1
293811 Xylose Tol 1-Hr/Pediatric/Ur 003511 Xylose, Urine, g/5hr g/5 hr 1646-9
293811 Xylose Tol 1-Hr/Pediatric/Ur 123101 Disclaimer: N/A
293811 Xylose Tol 1-Hr/Pediatric/Ur 016402 Xylose Tolerance (2 Spec) N/A

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf