Congestive cardiac failure following laxative withdrawal

Riley, J. A.; Brown, Autumn; Walker, Betrice

doi:10.1136/pgmj.72.850.491

Cited by 7 publications

(13 citation statements)

References 3 publications

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“…Considering that hypopotassemia can suppress secretion of aldosterone, interpreted to serve as a protective feedback mechanism against worsening of potassium disorder, it could be about another timing for starting spironolactone when hypopotassemia was dissolved. There may be another idea to use an angiotensin-converting enzyme inhibitor targeting at the activated renin-angiotensin system [3]. It should be kept in mind, however, that laxative abusers are generally hypovolemic and hypotensive at least at first, as seen in the present case where no hypertension was observed throughout the course.…”

Section: Discussionmentioning

confidence: 69%

“…1a). A similar case has been reported where strong body fluid retention occurred upon quitting abused laxatives, resulting in acute heart failure requiring furosemide to control [3]. Although the fast and strong effects of loop diuretics were preferable in controlling an acute phase of body fluid excess, we do not deny that spironolactone should have been one of the first to choose pathophysiologically, and that loop diuretics should be used secondarily.…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, patients withdrawing from laxatives often suffer from physical problems such as persisting edema, weight gain and constipation [2]. Behind these symptoms is strong body fluid retention which can bring about acute heart failure [3], or intestinal edema resulting in ileus in an extreme case [4].…”

Section: Introductionmentioning

confidence: 99%

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Diuretics-assisted treatment of chronic laxative abuse

2014

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Hypopotassemia with acid-base imbalance caused by laxative abuse is one of the disorders that nephrologists can be consulted for. Although laxatives are not supposed to form psychological dependence in themselves and their abuse should be cured theoretically by just finishing the overdose, the patients often resist treatment due to unpleasant symptoms such as edema and worsening constipation. Thus, chronic laxative abuse is often regarded as a drug addiction. We report a successfully treated case of chronic laxative abuse, where drastic reduction of laxatives was achieved by applying diuretics. After drastic reduction of laxatives, diuretics were added until they eased edema and bloating so that the patient could feel them to be tolerable, paying attention to lab data such as potassium and renal function. The diuretics, which substituted for laxatives in fluid control, could be tapered off over 3 months without any withdrawal symptoms or a need of additional laxatives. Our experience of simple but successful treatment of chronic laxative abuse emphasizes importance of physical management and suggests that there are cases where the two different kinds of drugs, laxatives and diuretics, can practically be regarded as swappable in the treatment of laxative abuse. This presentation should contribute to accumulation of knowledge in how to treat chronic laxative abuse where no standardized method is established yet.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 94%

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Diuretics-assisted treatment of chronic laxative abuse

2014

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“…Aldosterone stimulates retention of sodium with water and causes further excretion of potassium through both the renal and faecal routes. As a result, the level of potassium in serum declines 11,12 …”

Section: What Is Known and Objectivementioning

confidence: 99%

Adverse drug event of hypokalaemia‐induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports

Khan¹,

Khan

2020

J Clin Pharm Ther

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What is known and objective The imbalance in serum potassium caused by laxatives can negatively affect the cardiovascular system, leading to life‐threatening consequences. Our objective was to evaluate the reported evidence of adverse events related to the cardiac system due to laxative‐induced hypokalaemia from case reports. Methods A systematic electronic literature search of PubMed, Embase, the Cochrane Library and Science Direct was conducted for the period 1995‐2019. In these databases, search terms describing hypokalaemia and cardiotoxicity were combined with the term laxative use. Results and discussion Over the 23 years, 27 incidents were identified in 12 countries. There were 19 female and eight male patients, with ages ranging from 1 month to 93 years. The frequency of reported cases according to severity was the following: severe hypokalaemia 48%, moderate hypokalaemia 44.4% and mild hypokalaemia 7.4%. In 70% of patients, the effect of laxative on the heart was typical hypokalaemic electrographic changes, 7.4% showed abnormal changes in cardiac rhythm, whereas in 18.5%, the cardiotoxicity observed was a very serious kind. Two patients died due to severe cardiac effects. What is new and conclusion The laxatives—along with the involvement of some other contributing factors—caused mild‐to‐severe hypokalaemic cardiotoxicity. These factors were non‐adherence of the patient to the recommended dosage, laxative abuse, drug‐drug and drug‐disease interactions, non‐potassium electrolyte imbalances and the use of herbal laxatives. We recommend that laxatives and aggravating factors should be taken into account in the assessment of patients with suspected hypokalaemic cardiotoxicity.

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“…114 Additionally, laxative abuse has been associated with a specific type of tachycardia-torsades de pointessecondary to hypokalemia. 115 Cardiac failure was documented in response to laxative withdrawal in a 60-year-old woman, 116 and the change of diuretics was associated with hypokalemic cardiac arrest in another case. 117 Hypokaelmia appears to mediate these cardiac complications.…”

Section: Cardiovascular Complicationsmentioning

confidence: 99%

The medical complications associated with purging

Forney

Buchman‐Schmitt

Keel

et al. 2016

Intl J Eating Disorders

105

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Objective Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. Method Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. Results Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. Conclusions Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder.

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Congestive cardiac failure following laxative withdrawal

Cited by 7 publications

References 3 publications

Diuretics-assisted treatment of chronic laxative abuse

Diuretics-assisted treatment of chronic laxative abuse

Adverse drug event of hypokalaemia‐induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports

The medical complications associated with purging

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