Laxative-induced diarrhoea: a continuing clinical problem.
Journal: 1974/May - British Medical Journal
ISSN: 0007-1447
PUBMED: 4817188
Abstract:
Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.
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Br Med J 1(5907): 537-541

Laxative-induced Diarrhoea: A Continuing Clinical Problem

Abstract

Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.

Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.

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Selected References

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  • Adamic S, Bihler I. Inhibition of intestinal sugar transport by phenolphthalein. Mol Pharmacol. 1967 Mar;3(2):188–194. [PubMed] [Google Scholar]
  • AITCHISON JD. Hypokalaemia following chronic diarrhea from overuse of cascara and a deficient diet. Lancet. 1958 Jul 12;2(7037):75–76. [PubMed] [Google Scholar]
  • COGHILL NF, McALLEN PM, EDWARDS F. Electrolyte losses associated with the taking of purges investigated with aid of sodium and potassium radioisotopes. Br Med J. 1959 Jan 3;1(5113):14–19.[PMC free article] [PubMed] [Google Scholar]
  • Darlington RC. O-t-c laxatives. J Am Pharm Assoc. 1966 Sep;6(9):470–passim. [PubMed] [Google Scholar]
  • Fleischer N, Brown H, Graham DY, Deleña S. Chronic laxative-induced hyperaldosteronism and hypokalemia simulating Bartter's syndrome. Ann Intern Med. 1969 Apr;70(4):791–798. [PubMed] [Google Scholar]
  • Frame B, Guiang HL, Frost HM, Reynolds WA. Osteomalacia induced by laxative (phenolphthalein) ingestion. Arch Intern Med. 1971 Nov;128(5):794–796. [PubMed] [Google Scholar]
  • FRENCH JM, GADDIE R, SMITH N. Diarrhea due to phenolphthalein. Lancet. 1956 Apr 28;270(6922):551–553. [PubMed] [Google Scholar]
  • Goulston SJ, McGovern VJ. The nature of benign strictures in ulcerative colitis. N Engl J Med. 1969 Aug 7;281(6):290–295. [PubMed] [Google Scholar]
  • de GRAEFF, SCHUURS MA. Severe potassium depletion caused by the abuse of laxatives. One patient followed for 8 years. Acta Med Scand. 1960 May 5;166:407–422. [PubMed] [Google Scholar]
  • Hart SL, McColl I. The effect of the laxative oxyphenisatin on the intestinal absorption of glucose in rat and man. Br J Pharmacol Chemother. 1968 Mar;32(3):683–686.[PMC free article] [PubMed] [Google Scholar]
  • HEILBRUN N, BERNSTEIN C. Roentgen abnormalities of the large and small intestine associated with prolonged cathartic ingestion. Radiology. 1955 Oct;65(4):549–556. [PubMed] [Google Scholar]
  • Heizer WD, Warshaw AL, Waldmann TA, Laster L. Protein-losing gastroenteropathy and malabsorption associated with factitious diarrhea. Ann Intern Med. 1968 Apr;68(4):839–852. [PubMed] [Google Scholar]
  • HOUGHTON BJ, PEARS MA. Chronic potassium depletion due to purgation with cascara. Br Med J. 1958 Jun 7;1(5083):1328–1330.[PMC free article] [PubMed] [Google Scholar]
  • JEWELL FC, KLINE JR. The purged colon. Radiology. 1954 Mar;62(3):368–371. [PubMed] [Google Scholar]
  • KRAMER P, POPE CE. FACTITIOUS DIARRHEA INDUCED BY PHENOLPHTHALEIN. Arch Intern Med. 1964 Nov;114:634–636. [PubMed] [Google Scholar]
  • LITCHFIELD JA. Low potassium syndrome resulting from the use of purgative drugs. Gastroenterology. 1959 Oct;37:483–488. [PubMed] [Google Scholar]
  • Love DR, Brown JJ, Fraser R, Lever AF, Robertson JI, Timbury GC, Thomson S, Tree M. An unusual case of self-induced electrolyte depletion. Gut. 1971 Apr;12(4):284–290.[PMC free article] [PubMed] [Google Scholar]
  • Metcalfe-Gibson A, Ing TS, Kuiper JJ, Richards P, Ward EE, Wrong OM. In vivo dialysis of faeces as a method of stool analysis. II. The influence of diet. Clin Sci. 1967 Aug;33(1):89–100. [PubMed] [Google Scholar]
  • Morson BC. Histopathology of cathartic colon. Gut. 1971 Oct;12(10):867–868. [PubMed] [Google Scholar]
  • PERKINS JG, PETERSEN AB, RILEY JA. Renal and cardiac lesions in potassium deficiency due to chronic diarrhea. Am J Med. 1950 Jan;8(1):115–illust. [PubMed] [Google Scholar]
  • Phillips RA, Love AH, Mitchell TG, Neptune EM., Jr Cathartics and the sodium pump. Nature. 1965 Jun 26;206(991):1367–1368. [PubMed] [Google Scholar]
  • PLUM GE, WEBER HM, SAUER WG. Prolonged cathartic abuse resulting in roentgen evidence suggestive of enterocolitis. Am J Roentgenol Radium Ther Nucl Med. 1960 May;83:919–925. [PubMed] [Google Scholar]
  • Plumley PF. Radical surgery in the treatment of cathartic colon. Proc R Soc Med. 1973 Mar;66(3):243–244.[PMC free article] [PubMed] [Google Scholar]
  • Ramirez B, Marieb NJ. Hypokalemic metabolic alkalosis due to Carter's little pills. Conn Med. 1970 Mar;34(3):169–170. [PubMed] [Google Scholar]
  • Rawson MD. Cathartic colon. Lancet. 1966 May 21;1(7447):1121–1124. [PubMed] [Google Scholar]
  • SCHWARTZ WB, RELMAN AS. Metabolic and renal studies in chronic potassium depletion resulting from overuse of laxatives. J Clin Invest. 1953 Mar;32(3):258–271.[PMC free article] [PubMed] [Google Scholar]
  • Shields R, Mulholland AT, Elmslie RG. Action of aldosterone upon the intestinal transport of potassium, sodium, and water. Gut. 1966 Dec;7(6):686–696.[PMC free article] [PubMed] [Google Scholar]
  • Sladen GE. Effects of chronic purgative abuse. Proc R Soc Med. 1972 Mar;65(3):288–291.[PMC free article] [PubMed] [Google Scholar]
  • Smith B. Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut. 1968 Apr;9(2):139–143.[PMC free article] [PubMed] [Google Scholar]
  • Todd IP. Cathartic colon: surgical aspects. Proc R Soc Med. 1973 Mar;66(3):244–245.[PMC free article] [PubMed] [Google Scholar]
  • WITTOESCH JH, JACKMAN RJ, McDONALD JR. Melanosis coli: general review and a study of 887 cases. Dis Colon Rectum. 1958 May-Jun;1(3):172–180. [PubMed] [Google Scholar]
  • Wolff HP, Vecsei P, Krück F, Roscher S, Brown JJ, Düsterdieck GO, Lever AF, Robertson JI. Psychiatric disturbance leading to potassium depletion, sodium depletion, raised plasma-renin concentration, and secondary hyperaldosteronism. Lancet. 1968 Feb 10;1(7537):257–261. [PubMed] [Google Scholar]
  • WRONG O, METCALFE-GIBSON A, MORRISON RB, NG ST, HOWARD AV. IN VIVO DIALYSIS OF FAECES AS A METHOD OF STOOL ANALYSIS. I. TECHNIQUE AND RESULTS IN NORMAL SUBJECTS. Clin Sci. 1965 Apr;28:357–375. [PubMed] [Google Scholar]
Abstract
Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.
Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.
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