Laxatives, abuse

Vomiting, nasogastric suctioning, and chloride (secretory) diarrhea (villous adenoma or laxative abuse)... 

Miscellaneous (immobility, poor diet, laxative abuse, hormonal disturbances)... 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Chronic diarrhea lasts for longer than 4 weeks. Most cases result from functional or inflammatory bowel disorders, endocrine disorders, malabsorption syndromes and drugs (including laxative abuse). In chronic diarrhea, daily watery stools may not occur. Diarrhea may be either intermittent or persistent. 

Abuse of laxatives can lead to a number of health problems, including imbalances in the levels of minerals (electrolytes) in the body, which can lead to dehydration, tremors, weakness, blurry vision, and kidney damage. Laxatives can also change the way nerve endings in the colon work, which can cause the laxative abuser to need more laxatives to have a bowel movement. Other problems with the digestive system that can result from laxative abuse include an increased risk of colon infection (resulting from a loss of the protective cover that lines the colon), rectal pain, gas, and severe constipation. Finally, laxative abuse may lead to both cancerous and noncancerous tumors in the bowel. 

Abuse of diuretics can lead to problems similar to those resulting from laxative abuse. These include imbalances of certain minerals in the body. Of particular concern is potassium, which is needed at certain concentrations for the heart to pump correctly. Not having enough potassium in the body can lead to an irregular heartbeat, which can result in death. Kidney damage and dehydration are other health risks associated with diuretic abuse. 

The laxative abuser may present with contradictory findings, sometimes diarrhea or weight loss. Laxative abusers may also have vomiting, abdom-... 

Many agents, including antibiotics and other drugs, cause diarrhea (Table 23-2). Laxative abuse for weight loss may also result in diarrhea. 

Abuse/Dependency Chronic use of laxatives, particularly stimulants, may lead to laxative dependency, which in turn may result in fluid and electrolyte imbalances, steatorrhea, osteomalacia, vitamin and mineral deficiencies, and a poorly functioning colon. Also known as laxative abuse syndrome (LAS), it is difficult to diagnose. Cathartic colon Cathartic colon, a poorly functioning colon, results from the chronic abuse of stimulant cathartics. 

Diarrhea is the frequent passage of watery, unformed stools. Its many causes include IBS, infectious disorders, thyrotoxicosis, malabsorption, medication side effect, and laxative abuse. Attempts to treat diarrhea should first focus on the patient s list of medications followed by a search for an underlying systemic disorder. Opioids and 5-HT3 receptor antagonists, such as alosetron, slow motility and can therefore decrease or eliminate diarrhea. 

Laxative abuse includes symptoms of abdominal pain, weakness, fatigue, thirst, vomiting, edema, bone pain, fluid and electrolyte imbalance, hypoalbuminemia, and syndromes that mimic colitis. 

Long-term follow-up research has shown that about one-fourth of AN patients will recover and the rest will have either partial or no improvement. Mortality rates at 10 years are 6.6% and at 30 years are 18%-20% after presentation for treatment (Theander, 1985 Eckert et ah, 1995). Most follow-up studies of AN show patients with an earlier age onset (under age 18) to have a better chance of recovery. Purging behavior, self-induced vomiting, and laxative abuse are usually predictive of a worse outcome (Eckert et ah, 1995). 

Diuretics. These drugs cause the body to flush out fluids through urine. People who abuse diuretics for weight control may think losing water will mean losing weight. Like laxative abuse, however, this is both ineffective and dangerous. 

A 5 0-ml sample of urine should be collected on diree successive days in order to improve the chances of catching a laxative abuser. The colour of the urine should be noted heavy use of danthron colours the urine pink or blue. If die urine turns red when made alkaline, this may indicate the presence of phenolphthalein or a vegetable laxative. 

Diuretic and laxative abuse can cause tubule damage secondary to potassium and sodium depletion. 

Almroth S, Latham M C 1995 Rational home management of diarrhoea. Lancet 345 709-711 Eastwood M 1995 The dilemma of laxative abuse. Lancet 346 1115... 

Large bowel, cancer of, see Colorectal cancer Largo intestine, dietary fiber and, 144-147 Laxative abuse, 723... 

Malmquist J, Ericsson B, Hulten-Nosslin MB, Jeppsson JO, Ljungberg O. Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient. Postgrad Med J 1980 56(662) 862. ... 

Habitual, usually secretive, abuse of laxatives is much more common in women than in men and there is overlap with the anorectic/bulimic sjmdrome. Abuse of irritant agents such as senna and cascara have been the commonest varieties (SED-10, 704), but many proprietary laxatives have been abused. Abuse can lead to a condition characterized by chronic diarrhea, hjq)okalemia, and fluid depletion. The features also include hjq)omagnesemia, hjq)ocalcemia, and hjq)oalbuminemia, with thirst, lassitude, weight loss, edema, and occasionally osteomalacic bone pain and clubbing. In one small series of cases of laxative abusers, pseudo-Bartter s syndrome was induced the com-phcations included confusion, convulsions, muscle weakness (with or without paralysis or rhabdomyolysis), and... 

Meyers AM, Feldman C, Sonnekus MI, Ninin DT, MargoUus LP, WhaUey NA. Chronic laxative abusers with pseudo-idiopathic oedema and autonomous pseudo-Bartter s syndrome. A spectrum of metabolic madness, or new lights on an old disease S Afr Med J 1990 78(11) 631-6. 

Siegers CP, von Hertzberg-Lottin E, Otte M, Schneider B. Anthranoid laxative abuse—a risk for colorectal cancer Gut 1993 Aug 34(8) 1099-101. 

Wands JR, Weiss SW, Yard ley JH, MaddreyWC. Chronic inorganic mercury poisoning due to laxative abuse. Am J Med 1987 57 92-101. 

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