Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient

Malmquist, Jörgen; Ericsson, B.; Hultén‐Nosslin, Maj‐Britt; Jeppsson, Jan‐Olof; Ljungberg, Otto

doi:10.1136/pgmj.56.662.862

Cited by 23 publications

(10 citation statements)

References 3 publications

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“…The mechanism behind its development remains uncertain, although it can disappear after successful treatment of a given disorder. We feel that congenital finger clubbing was unlikely in this patient, as its presence was noted repeatedly in the notes 20 years prior to her current admission, but not so in many entries before this.In conclusion, our case complements the paucity of literature describing chronic laxative abuse as being a cause of finger clubbing [1][2][3][4] and illustrates that this knowledge may in turn avoid unnecessary investigations. Moreover, in patients where no cause of finger clubbing has been identified, clinical features suggesting laxative abuse should be actively sought.…”

supporting

confidence: 71%

“…In conclusion, our case complements the paucity of literature describing chronic laxative abuse as being a cause of finger clubbing [1][2][3][4] and illustrates that this knowledge may in turn avoid unnecessary investigations. Moreover, in patients where no cause of finger clubbing has been identified, clinical features suggesting laxative abuse should be actively sought.…”

supporting

confidence: 71%

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A rare cause of finger clubbing in a life‐long nonsmoker

Currie

Niruban

Dempsey

2006

Brit J Clinical Pharma

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A 62-year-old female life-long nonsmoker was referred to our department for investigation of persistent cough, weight loss, mild anaemia and gross finger clubbing. Her chest radiograph was essentially normal, computed tomographic imaging showed no significant abnormality and no endobronchial lesion was demonstrated during bronchoscopy.Her case notes became available only following her admission and it was discovered that finger clubbing had been documented 20 years earlier. She had a long history of abdominal pain and intermittent diarrhoea and had undergone numerous gastrointestinal investigations. Sigmoidoscopy 27 years earlier had demonstrated biopsy-proven melanosis coli and, combined with the finding of low potassium, suggested purgative abuse as a cause of her intestinal symptoms. During other admissions spanning several decades, her potassium was intermittently found to be low and urine had proven positive for anthraquinones. Her husband had confirmed an unusually large intake of laxatives by his wife, although this had been denied by the patient herself. During her admission for respiratory investigations, she was using laxatives (lactulose and senna) on a daily basis and despite mild chronic renal failure, her serum potassium was only 2.8 mmol l − 1 . Finger clubbing is associated with a wide range of pulmonary and nonpulmonary conditions and frequently raises the possibility of a serious underlying disorder. The mechanism behind its development remains uncertain, although it can disappear after successful treatment of a given disorder. We feel that congenital finger clubbing was unlikely in this patient, as its presence was noted repeatedly in the notes 20 years prior to her current admission, but not so in many entries before this.In conclusion, our case complements the paucity of literature describing chronic laxative abuse as being a cause of finger clubbing [1][2][3][4] and illustrates that this knowledge may in turn avoid unnecessary investigations. Moreover, in patients where no cause of finger clubbing has been identified, clinical features suggesting laxative abuse should be actively sought.

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supporting

confidence: 71%

supporting

confidence: 71%

A rare cause of finger clubbing in a life‐long nonsmoker

Currie

Niruban

Dempsey

2006

Brit J Clinical Pharma

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“…There are several single case reports of hypertrophic osteoarthropathy and clubbing of the digits occurring in association with long term senna intake (Armstrong et al 1981;Fitzgerald & Redmond 1985;Frier & Scott 1981;Levineet al 1981;Malmquist et al 1980;Prior & White 1978;Silk et al 1975). If the laxative abuse is stopped, both are said to regress (Armstrong et al 1981;Fitzgerald & Redmond 1985;Levine et al 1981;Silk et al 1975).…”

Section: Anthraquinonesmentioning

confidence: 99%

Adverse Effects of Drugs Used in the Management of Constipation and Diarrhoea

1994

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Most laxatives, if used intermittently in the absence of contraindications, are relatively safe. Bulking agents may diminish absorption of some minerals and drugs, but this is not usually clinically significant. Ispaghula can cause serious allergic reactions. The chronic ingestion of stimulant laxatives has been blamed for the development of the 'cathartic colon', but there are no definitive studies which have demonstrated this. Dantron (danthron) preparations should only be used in older patients and the terminally ill because of the risk of hepatotoxicity with this drug. Oral oxyphenisatine should no longer be used. Senna would appear to be the stimulant laxative of choice during pregnancy and lactation. Bisacodyl is the polyphenolic derivative of choice. Lactulose, sorbitol and lactilol rarely cause significant adverse effects. Magnesium salt laxatives and phosphate enemas can cause serious metabolic disturbances in babies and young children. Liquid paraffin is contraindicated if there is any risk of aspiration. Interference with the absorption of fat soluble vitamins would not appear to be clinically significant. Docusate sodium may potentiate the hepatotoxicity of other drugs, but reports of this are rare. The role of cisapride in constipation has not been established. Antidiarrhoeal drugs are second line drugs whose use is aimed at minimising inconvenience and discomfort. No antidiarrhoeals can be recommended for children under 4 years of age. Loperamide is the drug of choice in older children and adults. The atropine component of diphenoxylate/atropine combinations can cause significant adverse effects. Bismuth salicylate is an inconvenient treatment for travellers' diarrhoea as large frequent doses of the liquid formulation are needed. Some bismuth can be absorbed and there is the potential to cause encephalopathy. Octreotide, methysergide and cholestyramine have a role for specific causes of diarrhoea only. Octreotide is effective in high output states from the small or large bowel, with few adverse effects. Clonidine and lidamidine may have a role in the treatment of chronic diabetic diarrhoea. The role of lidamidine in nondiabetic chronic diarrhoea has not been established.

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“…Clubbing of the fingers with or without hypertrophic osteopathy has also been attributed to the chronic use of purgatives in excessive doses [48][49][50][51][52].…”

Section: Osteopathic Reactionsmentioning

confidence: 99%

Anthranoid Derivatives — General Discussion

Westendorf¹

1993

Adverse Effects of Herbal Drugs 2

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Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient

Cited by 23 publications

References 3 publications

A rare cause of finger clubbing in a life‐long nonsmoker

A rare cause of finger clubbing in a life‐long nonsmoker

Adverse Effects of Drugs Used in the Management of Constipation and Diarrhoea

Anthranoid Derivatives — General Discussion

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