Surreptitious laxative abuse

Morris, A. I.; Turnberg, L A

doi:10.1016/0016-5085(79)90237-3

Cited by 30 publications

(9 citation statements)

References 18 publications

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“…Osmotic diarrhoea was defined as FOG >100 mosmol/l and secretory diarrhoea as FOG ⩽100 mosmol/l 23 7 9Continuous variables were compared with the t test (two tailed) or non-parametric Kruskal-Wallis tests, and discrete variables by either χ 2 or Fisher’s exact tests (two tailed), as appropriate. The Epi-Info software (V.5.00, CDD-WHO, 1990) was used to store and process the data.…”

Section: Methodsmentioning

confidence: 99%

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Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements

Castro-Rodriguez¹,

Salazar–Lindo

León-Barúa

1997

Archives of Disease in Childhood

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Clinical features and laboratory tests that determine carbohydrate in faeces were evaluated to determine which was best able to distinguish between osmotic and secretory diarrhoea in infants and children. For this purpose 80 boys aged 3 to 24 months, with acute watery diarrhoea, were studied prospectively. The faecal osmolar gap (FOG) was calculated as: serum osmolarity − [2 × (faecal sodium + potassium concentration)]. Fifty eight patients were classified as having predominantly osmotic diarrhoea (FOG >100 mosmol/l), and 22 as having predominantly secretory diarrhoea (FOG <100 mosmol/l). The two groups were comparable in their clinical features on admission, in the results of blood and urine tests, and in the evolution of their diarrhoeal illness. Evidence of steatorrhoea (by positive Sudan III test) and of acid faecal pH on admission were significantly more frequent in patients with osmotic diarrhoea. Mean (SD) faecal osmolarity was not significantly diVerent between the two groups (319 (80) mosmol/l in secretory diarrhoea v 361 (123) mosmol/l in osmotic diarrhoea). Tests for reducing substances in faeces such as Benedict's test-with and without hydrolysis-and glucose strip, all showed a positive and significant association with osmotic diarrhoea (p <0.05, <0.025, <0.05, respectively). The presence of excess reducing substances (Benedict's test with hydrolysis >++) on admission was the most sensitive and specific test with the best predictive value for diVerentiating between the two types of watery diarrhoea. (Arch Dis Child 1997;77:201-205) Keywords: diarrhoea; faecal osmolar gap; carbohydrate malabsorption Enteropathogens that cause diarrhoea may aVect the physiology of the gut in diVerent ways. By modifying the equilibrium of water and electrolytes, they can induce diVerent types of diarrhoea. Thus, osmotic diarrhoea results from an excess of non-absorbable and osmotically active solutes in the lumen, and secretory diarrhoea results when the secretory activity of the mucosa exceeds its absorption capacity.

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Section: Methodsmentioning

confidence: 99%

“…Several studies in adults with laxative induced persistent diarrhoea have used an arbitrary definition of osmotic diarrhoea as a mean (SD) serum value for FOG higher than 40, 4 50, 8 or 100 mosmol/l respectively 23 7 9 The latter value is now the most widely accepted,2 3 7 9 although it has never been validated in acute infantile diarrhoea.…”

mentioning

confidence: 99%

Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements

Castro-Rodriguez¹,

Salazar–Lindo

León-Barúa

1997

Archives of Disease in Childhood

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“…Biegunka osmotyczna może powodować wydzielanie tłuszczu i substancji azotowych do stolca, ale zazwyczaj nie powoduje krwawienia z odbytu. Objętość stolca zmniejsza się podczas postu, ale luka osmotyczna stolca wynosi ≥ 50 mOsm/kg [19].…”

Section: Biegunka Osmotycznaunclassified

Diarrhea in cancer patients

Badian¹,

Dzierżanowski²

2018

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S t r e s z c z e n i e Biegunka jest nieprzyjemnym objawem, który pogarsza jakość życia pacjentów z chorobą nowotworową. Dotyczy ponad połowy pacjentów leczonych niektórymi schematami chemioterapii, występuje u ok. 10% chorych przyjmowanych do hospicjum. Wyróżnia się postać ostrą, której przyczyną w ponad 90% jest infekcja, oraz postacie przewlekłe, głównie o etiologii zapalnej. Do zastosowania odpowiedniego leczenia niezbędne jest określenie przyczyn biegunki. Słowa kluczowe: biegunka, farmakoterapia, chory na nowotwór. A b s t r a c tDiarrhea is an unpleasant symptom that decreases the quality of life of cancer patients. It affects over half of patients on some types of chemotherapy, and about 10% of patients admitted to a hospice. There is an acute form, in which in 90% of cases the cause is an infection, and chronic forms mainly of inflammatory etiology. Establishing the etiology of diarrhea is crucial for the right choice of treatment.

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“…When these tests were applied to patients with chronic diarrhea, they often revealed abnormalities that suggested the presence of neuroendocrine tumors or inflammation of gastrointestinal mucosa. Although it was not well recognized at the time, many of these "abnormalities" actually represented false-positive results (22), which often led to exploratory laparotomy, pancreatic resection, small intestinal or colon resection, or prolonged treatment with corticosteroids (20,(23)(24)(25)(26)(27). e result was an epidemic of severe and serious iatrogenic disease.…”

Section: Factitious Diarrhea Due To Surreptitious Ingestion Of Laxatimentioning

confidence: 99%

Factitious Disease: Clinical Lessons from Case Studies at Baylor University Medical Center

Savino¹,

Fordtran²

2006

Baylor University Medical Center Proceedings

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Factitious disease is defined as the intentional production (or feigning) of disease in oneself to relieve emotional distress by assuming the role of a sick person. Although the self-induction of disease is a conscious act, the underlying motivation is usually unconscious. It has been estimated that 3% to 5% of physician-patient encounters involve factitious disease. This article presents 6 case studies from Baylor University Medical Center that highlight various clinical aspects of factitious disease. Patients with factitious diseases are extremely difficult to recognize because they do not appear different from patients with authentic causes of similar symptoms, because their psychiatric abnormalities are not appreciated, and because doctors and nurses have alowindex of suspicion. Since patients with factitious disease present a false medicalhistory, their physicians prescribe unnecessary procedures and therapies that may result in iatrogenic disease. In many cases, damage to these patients from doctors' actions exceeds the harm resulting from the patients' self-induced illness. The clues that should suggest factitious disease, the diagnostic roles of the clinician and a consulting psychiatrist, and the ethical conflicts that confront doctors taking care of such patients are discussed. To help keep factitious disease in clinical perspective, one of the case studies involves the antithesis of factitious disease, where a patient was mistakenly diagnosed as having psychogenic pain when in fact the symptoms were caused by an overlooked physical disease. Better knowledge of the clinical features of factitious disease might have prevented the disastrous outcome.

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Surreptitious laxative abuse

Cited by 30 publications

References 18 publications

Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements

Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements

Diarrhea in cancer patients

Factitious Disease: Clinical Lessons from Case Studies at Baylor University Medical Center

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