Optimal Result: 0 - 75 mmol/mol creatinine.

4-Cresol is predominantly produced by C. difficile, a pathogenic bacteria, that is one of the most common pathogens spread in hospitals.

What C. difficile can cause:

Toxin-producing strains of C. difficile can cause illness ranging from mild or moderate diarrhea to pseudomembranous colitis, which can lead to toxic dilatation of the colon (megacolon), sepsis, and death.

4-Cresol has been used as a specific marker for Clostridium difficile.

4-Cresol, a phenolic compound, is classified as a type-B toxic agent and can cause rapid circulatory collapse and death in humans.

High amounts of 4-Cresol have been found in autism (L); the amount of 4-Cresol in the urine has been found elevated in baseline samples and in replica samples of autistic children. Higher values of 4-Cresol are found in girls with autism compared to boys with autism and higher values are associated with greater clinical severity of autistic symptoms and history of behavioral regression. 4-Cresol is apparently produced by Clostridia difficile as an antimicrobial compound that kills other species of bacteria in the gastrointestinal tract, allowing the Clostridia difficile to proliferate and predominate.


- Urinary p-cresol in autism spectrum disorder. (L)

What does it mean if your 4-Cresol result is too high?

Elevated values of 4-Cresol indicate overgrowth of C. difficile in the GI tract. This metabolite is commonly elevated in GAPS cases. Inhibits the enzyme dopamine-beta-hydroxylase, leading to neurotransmitter imbalances.

C. difficile naturally occurs in the gut. When the bacterium is present at normal levels, doctors do not consider C. difficile to be an infection.

This bacterium does not usually cause problems for people who are otherwise healthy. However, some antibiotics may alter the balance of bacteria in the gut, allowing C. difficile to multiply. It is at this stage that it becomes an infection.

The infection can cause diarrhea and increase the risk of more serious illnesses.

Most cases of C. difficile infection occur in healthcare environments due to their link with antibiotic therapy. A significant number of people staying in the hospital will need to take a course of antibiotics to treat other infections.

The following symptoms may occur as a result of C. difficile infection:

- watery diarrhea
- frequent bowel movements
- fever
- pain or tenderness in the stomach
- nausea
- reduced appetite

Inflammation of the lining of the large intestine, or colitis, causes these symptoms. Although complications are rare, C. difficile can also lead to:

- peritonitis, or infection of the lining of the abdomen
- septicemia, or blood poisoning
- perforation of the colon

More noticeable symptoms can include:

- dehydration
- elevated body temperature
- loss of appetite
- severe abdominal cramping and pain
- nausea
- pus or blood in the feces
- needing to use the bathroom 10 or more times per day
- weight loss

The risk of experiencing a life threatening condition is higher among older people and those with serious health conditions.

Most symptoms develop in people who are taking antibiotic medications. It is not unusual for symptoms to appear 6 weeksTrusted Source after the end of antibiotic therapy.

Standard treatment for a C. difficile infection is antibiotics. 

If a person is taking antibiotics when symptoms appear, a doctor may consider stopping that course and prescribing a new type.

However, treatment with antibiotics may make a C. difficile infection worse by attacking the helpful bacteria in the body.

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