Fermentation of malabsorbed carbohydrate (CHO) reaching the colon was studied by measuring peak breath hydrogen (H2) production between feedings in 28 H2-producing hospitalized infants with diarrhea. Patients who required fewer than six days of hospitalization had lower breath H2 values when tested soon after admission than those who required longer stays. Patients hospitalized for more than five days had lower H2 amounts at discharge than on admission. Peak breath H2 values decreased when glucose was substituted for glucose polymers in formulas, or when the formula was fed by continuous drip via a nasogastric tube instead of by orally administered bolus. Glucose-positive and acidic stools were encountered occasionally and were associated with decreased H2 levels. The responses of H2 levels, stool pH, and glucose excretion after changes in patient management or intestinal metabolism of CHO reflect alterations in the balance between proximal intestinal absorption and distal colonic fermentation. Malabsorbed CHO that reaches a competent colon is utilized via microbial conversion, as indicated by high H2 levels, in the absence of glucose-positive and acidic stools. The presence of glucose in the feces or acidic stools indicates an inability of the colon to completely metabolize and absorb CHO or its products of fermentation.