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laxative abuse
Associated with chronic use of stimulant laxatives.
Clinical manifestations:
1) chronic constipation progressing to chronic diarrhea
2) continuous feeling of need to defecate
3) sensation of incomplete evacuation
4) anthracene-containing laxatives cause the colonic mucosa to darken
Laboratory:
- normal anion gap metabolic acidosis
- NEJM asserts symptomatic hypokalemia without metabolic alkalosis [3]
- serum potassium: hypokalemia
- urinalysis:
- negative urinary anion gap consistent with GI loss of HCO3=
- urine chloride low
Management:
1) decrease laxative use
2) retrain to normal bowel schedule
3) often frustrating to both patient & physician
Related
laxative
General
intestinal disease
substance abuse
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17.
American College of Physicians, Philadelphia 1998, 2012, 2015
- Roerig JL, Steffen KJ, Mitchell JE, Zunker C.
Laxative abuse: epidemiology, diagnosis and management.
Drugs. 2010 Aug 20;70(12):1487-503. Review.
PMID: 20687617
- NEJM Knowledge+ Nephrology/Urology