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CEN Case Reports

, Volume 3, Issue 2, pp 209–214 | Cite as

Diuretics-assisted treatment of chronic laxative abuse

  • Yuichi Shirasawa
  • Michio Fukuda
  • Genjiro Kimura
Case Report

Abstract

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.

Keywords

Laxative abuse Senna Edema Diuretics Pseudo-Bartter syndrome 

Notes

Conflict of interest

All the authors have declared no competing interest.

References

  1. 1.
    Tozzi F, Thornton LM, Mitchell J, Fichter MM, Klump KL, Lilenfeld LR, Reba L, Strober M, Kaye WH, Bulik CM. Features associated with laxative abuse in individuals with eating disorders. Psychosom Med. 2006;68:470–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Meyers AM, Feldman C, Sonnekus MI, Ninin DT, Margolius LP, Whalley 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;78:631–6.PubMedGoogle Scholar
  3. 3.
    Riley JA, Brown AR, Walker BE. Congestive cardiac failure following laxative withdrawal. Postgrad Med J. 1996;72:491–2.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Yokoyama S, Koide Y, Washizuka T, Kitahara A, Takahashi T, Amano N. Jpn J Gen Hosp Psychiatry. 2002;14:194–9 (Article in Japanese).Google Scholar
  5. 5.
    Batlle DC, von Riotte A, Schlueter W. Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. N Engl J Med. 1987;316:140–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Korzets Z, Hasdan G, Podjarny E, Bernheim J. Excessive fluid gain in a chronic laxative abuser: “pseudo-idiopathic” oedema. Nephrol Dial Transplant. 2002;17:161–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Leng-Peschlow E. Sennoside-induced secretion is not caused by changes in mucosal permeability or Na + , K(+)-ATPase activity. J Pharm Pharmacol. 1993;45:951–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Leng-Peschlow E. Sennoside-induced secretion and its relevance for the laxative effect. Pharmacology. 1993;47(Suppl 1):14–21.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2014

Authors and Affiliations

  • Yuichi Shirasawa
    • 1
  • Michio Fukuda
    • 1
  • Genjiro Kimura
    • 2
  1. 1.Department of Cardio-Renal Medicine and HypertensionNagoya City University School of MedicineNagoya CityJapan
  2. 2.Asahi Rosai Hospital, Japan Labour Health and Welfare OrganizationOwariasahi CityJapan

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