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Epic Code LAB3097 Lactose Intolerance, Breath Test

Important Note

  • This test must be scheduled through a Spectrum Health provider office (via Epic) OR through the Spectrum Health App, MyChart. Order must be in Epic prior to scheduling. More Information.
  • This test is performed at the Butterworth Outpatient Lab (100 Michigan) (click on the link for directions)
  • There are 4 appointments daily Monday-Friday. 
  • Appointments last up to 3.5 hours.
  • Patients that wishes to cancel upccoming breath test appointments, please call 616.774.5600
  • Fasting specimen required

Test Name Alias

Lactose Intolerance Breath Test | H2 Breath Test for Lactose Intolerance | 4133

Interface Order Alias

10399

Clinical Information

This test was developed and its performance characteristics determined by Spectrum Health Laboratory. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for clinical purposes. It should not be regarded as investigational or for research.

Ordering Instructions

Test must be ordered prior to scheduling.

Collection Instructions

Improper specimen collection can adversely affect the outcome of the test. Specimen collection should only be performed by staff with experience in proper specimen collection procedures.

 

Patient will consume Lactose (gluten free)

 

Specimen Type: Alveolar, air from properly prepared patient, who ingested lactose.
Container/Tube: Collection bags (total 7 bags)

Minimum volume: 40 mL

 

LINK: Patient Preparation

 

For pediatric patients weighing less than 55 pounds contact the Spectrum Health (Butterworth Hospital) Outpatient Pharmacy at 616.267.1807 with the patient’s weight and the test being performed (Lactose Intolerance Breath Test) so that they can adjust the amount of LACTOSE administered according to the following formula:
 

Divide the child’s weight (up to 55 pounds) by 6.9.  Then multiply this number by 3.125 to obtain the number of grams of lactose to weigh out. Example:  if child weighs 35 pounds, you would weigh out 15.9 gm of lactose and dilute this in 8 ounces of water. (({35 lbs ¸ 6.9} x 3.125) = 15.9 gm)

 

Specimen Stability

Ambient: 6 Hours

Test Frequency

By schedule only, test is available Monday – Friday. Usual TAT 1-2 days.

Reference Range

Any time during the test, a 20 ppm increase in hydrogen gas over the lowest preceding value indicates lactose deficiency

Performing Department

IMMUNOCHEMISTRY

Performing Department Laboratory Location

Spectrum Health Regional Laboratory, Grand Rapids, MI

Methodology

Gas chromatograph

CPT

91065

CDM Code

4054133

Epic Test ID

1230100870

LOINC

Fasting H2 Breath: 33490-4

30 Minutes H2 Breath: 50000-9

60 Minutes H2 Breath: 50001-7

90 Minutes H2 Breath: 50002-5

120 Minutes H2 Breath: 50003-3

150 Minutes H2 Breath: 50013-2

180 Minutes H2 Breath: 50004-1

Lactose Intolerance Comment: 8251-1

Beaker LOINC

120 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50003-3
150 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50013-2
180 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50004-1
30 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50000-9
60 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50001-7
90 MINUTES LACTOSE INTOLERANCE HYDROGEN BREATH: 50002-5
FASTING LACTOSE INTOLERANCE HYDROGEN BREATH: 33490-4

Reviewed Date

12/13/2021

Beaker Names

Beaker Procedure Name: HYDROGEN BREATH LAB
Beaker Display Name: Lactose Intolerance, Breath Test
BEAKER TEST NAME: LACTOSE INTOLERANCE BREATH TEST
BEAKER TEST REPORT NAME: Lactose Intolerance Breath Test

Beaker Synonyms

No synonym on file

Beaker Collection and Specimen Handling

BEAKER COLLECTION: Schedule before draw

Beaker Location, Container and Temperature

BW IMMUNOCHEM: HYDROGEN BREATH BAG (Preferred)-Ambient