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PubMed1996

Colonic pseudo-obstruction in burns patients.

Acute pseudo-obstruction is a rare complication in burns patients. An awareness of the factors implicated in its pathogenesis such as prolonged bed rest, narcotic medications, hypokalaemia, sepsis and surgery (all commonly associated with burns patients) is essential if this condition is to be avoided. Early diagnosis, prokinetic and cathartic agents, and aggressive endoscopic intervention are essential to halt the progression of caecal dilatation. Excisional surgery and stoma formation are necessary for salvage of complicated colonic pseudo-obstruction.

Accidents, Occupational↗
PubMed1976

Hydrocarbon ingestion in children: a six-year retrospective study.

The results of a six-year retrospective study of 116 children admitted with the diagnosis of hydrocarbon ingestion showed that the major toxicity of hydrocarbons was to the respiratory tract, with 79 patients (68%) developing pneumonia. There was a significantly higher initial white blood cell count in children who developed pneumonia (15,900/cu mm vs 12,000/cu mm, p less than .001). All hydrocarbon products studied had a similar incidence of complicatons, except turpentine products, which had a significantly lower incidence of pneumonia (p less than .005). There was no correlation between amount ingested and development of complicatons. Initial treatment, which consisted of induced vomiting, gastric lavage, administration of oil or saline cathartics, was not associated with fewer complications. Oil administration correlated with higher incidence of pneumonia (p less than .025). The present study recomends only supportive treatment following hydrocarbon ingestion in children.

Cathartics↗
PubMed2002

New developments in the therapy of intoxications.

There has been a significant evolution in the clinical management of the poisoned patient over the last decade. Interventions that were once the cornerstone of treating the poisoned patient have become passé or have come under intense scrutiny. The advent of evidence-based medicine has forced clinical scientists to re-evaluate standard therapies. Gastrointestinal decontamination with either emesis or gastric lavage was the foundation of the initial management of most poisoned patients. Examination of the published literature demonstrated that neither emesis nor lavage changed the ultimate outcome of poisoned patients, and most poison centers have abandoned their use. Even the use of activated charcoal has been questioned. A multitude of studies demonstrated that the effectiveness of activated charcoal diminished significantly 30-60 min after the ingestion of a poison. No study has demonstrated that charcoal changed patient outcome. Cathartics have been deemed to be ineffective and potentially dangerous and are never indicated. Whole bowel irrigation should not be used routinely in the management of the poisoned patient. Multiple dose activated charcoal and urinary alkalinization, commonly used to enhance the elimination of some poisons, have limited usefulness. While these 'old' and more general methods of 'detoxification' have thus failed in most cases to improve or change patient outcome, the use of more specific antidotes, tailored to the exact cause of intoxication is to be considered. Very few antidotes, however, are used on a consistent basis in the management of poisoned victims. The indiscriminate use of antidotes may even be harmful to the patient and incur an inordinate expense. In addition to the commonly known antidotes N-acetylcysteine (acetaminophen, paracetamol), naloxone (opioids) and flumazenil (benzodiazepines), new antidotes include fomepizole to treat ethylene glycol and methanol poisoning and Crotalidae Polyvalent Immune Fab (Ovine) for pit viper envenomation.

Antidotes↗
PubMed2001

Antidiarrhoeal activity of piperine in mice.

Peppers are common food ingredients used worldwide. They are also added in traditional antidiarrhoeal formulations of different herbs. Piperine (1) is an alkaloidal constituent of black and long peppers recently established as a bioavailability enhancer of drugs and other substances. As a part of efforts to study its effects on the gastrointestinal tract, the experiments were performed to determine the rationale, if any, for its use in traditional antidiarrhoeal formulations. Antidiarrhoeal activity of 1 against castor oil, MgSO4 and arachidonic acid was studied in mice. It significantly inhibited diarrhoea produced by these cathartics at 8 and 32 mg/kg p.o. dose. Inhibition of castor oil induced enteropooling by 1 suggests its inhibitory effect on prostaglandins. The results validate the rationale for its use in traditional antidiarrhoeal formulations.

Alkaloids↗
PubMed1989

[Senna-containing laxatives: excretion in the breast milk?].

The excretion of rhein, a cathartic with active metabolite from sennosides, was investigated in breast milk samples of 15 post-partum women for at least 24 h after the intake of a therapeutic dose (15 mg sennosides/day) of a standardized, fiber containing senna laxative (Agiolax). Rhein was analyzed by a HPLC-method with a lower limit of detection at 1 ng/ml rhein, taking into account a possible binding as monoglucuronide and monosulfate. Maximal concentrations up to 27 ng/ml and in 89% values below 10 ng/ml were measured. Related to the daily milk volume, 73% of the women excreted less than 2 ng rhein/day. Based on median values, 0.017% of the sennoside intake (calculated as rhein) was excreted in breast milk. The amount of rhein transmitted to the infant is therefore 0.3% of the rhein intake of the mother. This is far below the oral rhein dose necessary for inducing a laxative effect. Accordingly, none of the breast-fed infants (n = 8) showed any difference in stool consistency in comparison with the non breast-fed infants.

Adult↗
PubMed1988

Treatment of constipation in the elderly.

About $250 million a year are spent on laxatives in the United States, attributable in large portion to the elderly. However, before laxative therapy is started in these patients, adequate exercise, ample fluids, and a high-fiber diet should be recommended. If these measures are unsuccessful and underlying disease is excluded, laxative use may be considered. Selection of the most appropriate cathartic for the clinical situation is vital. Bulk-forming laxatives and lactulose are favored. Dietary and drug intake should be discussed with the patient and constipating items eliminated when possible. Enema therapy may be necessary to retrain or evacuate an atonic, constipated colon. The mnemonic, right, summarizes the major points in treating constipation.

Aged↗
PubMed1992

Acute poisoning emergencies. Resolving the gastric decontamination controversy.

As in all medical emergencies, in acute poisoning the cornerstone of management is good supportive care. Aggressive support of the cardiovascular, respiratory, and central nervous systems, along with appropriate gastric decontamination, greatly reduces morbidity and mortality and improves patient outcome. Ipecac is generally reserved for home use, where it can be given to induce emesis immediately after ingestion of toxins, and it is given only in cases of mild or moderate toxicity. Activated charcoal should replace ipecac in the emergency department for cases of mild or moderate toxicity. Gastric lavage and administration of activated charcoal should be considered in cases with life-threatening potential. A cathartic should be considered after activated charcoal has been administered, but only in cases where it will not have a detrimental effect.

Acute Disease↗
PubMed1992

Gastrointestinal decontamination. Which method is best?

Why has ipecac syrup become less popular in emergency management of poisoning and overdose? When should gastric lavage, activated charcoal, cathartics, or a combination of methods be used? Which patients are candidates for whole-bowel irrigation with polyethylene glycol-electrolyte solution? Drs Harris and Kingston answer these questions and present their recommendations for each of the available management options.

Cathartics↗
PubMed2006

Jimsonweed (Datura stramonium) exposures in Texas, 1998-2004.

For centuries, jimsonweed, Datura stramonium, was known to produce hallucinogenic effects. Jimsonweed is easily obtained and may be abused by adolescents. This investigation examined the patterns of jimsonweed exposures reported to Texas poison control centers during 1998-2004. A total of 188 reported human exposures were identified. Seventy-six percent of the exposures occurred in June-October. For those cases where the information was known, the majority were male (82%) and age 13-19 yr (72%). Intentional abuse or misuse accounted for 78% of reported exposures. Eighty-two percent of the reported exposures were at, en route to, or referred to health care facilities, and 89% of those cases with a known medical outcome had moderate or major effects. The most frequently reported clinical effects were hallucination, tachycardia, agitation, mydriasis, and confusion; the most frequently reported treatments were intravenous fluids replacement, activated charcoal, cathartic, and benzodiazepines. The pattern of reported jimsonweed exposures in Texas was consistent with previously published literature.

Adolescent↗
PubMed1988

Oral hydration solutions in experimental osmotic diarrhea: enhancement by alanine and other amino acids and oligopeptides.

Improvement of sodium absorption during the administration of oral hydration solutions (OHS) could increase the efficacy of formulations used in the treatment of infantile diarrhea. To test this hypothesis, selected protein breakdown products were evaluated as absorption enhancers in OHS of different osmolalities and Na-to-glucose ratios in an animal model of osmotic diarrhea induced by cathartics. A very significant increase in water and Na absorption occurred in rats with diarrhea when they were perfused with a 90-mmol/L-Na, 111-mmol/L-glucose OHS containing 30 mmol/L of L-alanine (Ala). The same effect on Na retention was observed with a protein hydrolysate (PrH) in rats with diarrhea. Glycine was not effective. Other experimental OHS were ineffective in rats with diarrhea. The data indicate that in this animal model of chronic diarrhea Na transport enhancers, such as Ala and a PrH, are most efficacious in the presence of higher Na concentration.

Absorption↗
PubMedDate not supplied

Laxative poisoning: toxicological analysis of bisacodyl and its metabolite in urine, serum, and stool.

An 11-year-old boy was hospitalized because of severe diarrhea (over 5 L/day). The child survived; however, the diarrhea continued while he was given intravenous fluids and his electrolyte balance was closely supervised. Based on observation of the patient and his family in the hospital, surreptitious administration of a poison by his mother was suspected, and toxicological analysis was carried out on stools from the boy and on medicine administered to him by his mother. Bisacodyl, a cathartic with a direct effect on the colon, was detected in the medicine, and a metabolite of bisacodyl was present in the stool. We devised a sensitive and reliable method to quantitate the bisacodyl metabolite in urine and serum. The sample was incubated with beta-glucuronidase at 37 degrees C for 2 h; bisacodyl metabolite was extracted with tert-butyl methyl ether, then derivatized by methylation, and subjected to gas chromatography-mass spectrometry. Bisphenol A was used as an internal standard. The calibration curve was linear in the concentration range from 2 to 1000 ng/0.2 mL, and the lower limits of detection were 1 ng/0.2 mL for the urine and 2 ng/0.2 mL for the serum. As concentrations of bisacodyl metabolite in the urine and serum of the patient were clearly defined, perhaps such investigations are warranted before extensive clinical therapy is prescribed.

Bisacodyl↗
PubMed2000

Does bowel preparation improve the quality of abdominal gallium scintigraphy?

Physiological accumulation of gallium in the intestine is a major weakness of gallium scintigraphy in evaluating the abdomen. In this study, we used two different cathartics to evaluate the efficacy of bowel cleansing in improving the quality of abdominal gallium imaging. One hundred and fifty patients underwent gallium scintigraphy and were randomly divided into three groups. Group A received no bowel preparation, Group B received 30 ml of castor oil the night before imaging, and Group C received bisacodyl the night before imaging. Gallium activity in the intestine was rated on a three-point scale from 0 to II based on the anterior view of a delayed 48-h gallium image. Our data showed that the incidence of gallium accumulation in the small intestine was low. On the contrary, there was high prevalence of gallium activity in the colon. Forty-eight percent of Group A patients had obvious gallium activity in the colon. The percentage decreased significantly to 28% and 22% in Groups B and C, respectively. No significant difference was noted between Group B and Group C. In conclusion, our data suggest that the application of either castor oil or bisacodyl significantly improves the quality of 48-h abdominal gallium scintigraphy. There were no significant differences in the efficacy of bowel cleansing on gallium activity between these two laxatives.

Abdomen↗
PubMed1980

Interaction of laxatives with enzymes of cyclic AMP metabolism from human colonic mucosa.

The mechanism by which laxatives such as dioctyl sodium sulfosuccinate and ricinoleic acid evoke colonic fluid secretion has been suggested to involve mucosal cyclic AMP. Ricinoleic acid and dioctyl sodium sulfosuccinate were tested for their capacity to modulate the key enzymes of cAMP-metabolism--adenylate cyclase and cAMP-phosphodiesterase--in human colonic mucosa. Both laxatives were ineffective stimuli of human colonic adenylate cyclase. In contrast to ricinoleic acid, dioctyl sodium sulfosuccinate was a competitive inhibitor of soluble cAMP-phosphodiesterase activity. These experiments suggest that the cathartic properties of dioctyl sodium sulfosuccinate in human colonic mucosa might be mediated by cyclic AMP via inhibition of soluble phosphodiesterase activity.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMedDate not supplied

Successful treatment of massive carbamazepine overdose.

Overdose of carbamazepine (CBZ) can be fatal. We report the case of a patient with near-lethal toxicity due to delayed absorption of drug. A 36-year-old woman was admitted with coma, hypotension, and unusual movements. Carbamazepine (CBZ) level several hours later was 36 mg/L. Gastric lavage revealed no pill fragments, and activated charcoal was administered. CBZ level initially fell, reaching 28 mg/L 36 h after admission. Blood level then rose sharply, reaching 54 mg/L 64 h after admission. The pattern of rise suggested renewed absorption of drug. Vigorous cathartics were given, and further doses of charcoal were administered. Three hours after onset of diarrhea, roving eye movements occurred. Two hours later she grimaced to pain. Eight hours after the onset of diarrhea, she was awake. In CBZ overdose, activated charcoal therapy coupled with aggressive intestinal purging helps prevent continued absorption of drug, late exacerbation of symptoms, and potentially fatal outcome.

Absorption↗
PubMed1993

Antidiarrhoeic activity of quercitrin in mice and rats.

Quercitrin, a flavonoid isolated from Euphorbia hirta, shows antidiarrhoeic activity at doses of 50 mg kg-1, against castor oil- and PGE2-induced diarrhoea in mice, but not when magnesium sulphate is used as a cathartic agent. It also delays rat small intestinal transit if this is accelerated with castor oil. However, the flavonoid does not modify the fluid transport across the colonic mucosa when it is administered intraluminally, either in normal conditions or when this transport is altered by PGE2 or sodium picosulphate. However, quercetin, the aglycone of quercitrin, increases the colonic fluid absorption only in the presence of secretagogue compounds, such as PGE2 and sodium picosulphate. It is concluded that the antidiarrhoeic activity of quercitrin is due to its aglycone, quercetin, which is released by the glycoside in the intestine.

Animals↗
PubMed2003

Weight loss practices of college wrestlers.

PURPOSE: The purpose of this investigation was to examine the weight management (WM) behaviors of collegiate wrestlers after the implementation of the NCAA's new weight control rules. METHODS: In the fall of 1999, a survey was distributed to 47 college wrestling teams stratified by collegiate division (i.e., I, II, III) and competitive quality. Forty-three teams returned surveys for a total of 741 responses. Comparisons were made using the collegiate division, weight class, and the wrestler's competitive winning percentage. RESULTS: The most weight lost during the season was 5.3 kg +/- 2.8 kg (mean +/- SD) or 6.9% +/- 4.7% of the wrestler's weight; weekly weight lost averaged 2.9 kg +/- 1.3 kg or 4.3% +/- 2.3% of the wrestler's weight; post-season, the average wrestler regained 5.5 kg +/- 3.6 kg or 8.6% +/- 5.4% of their weight. Coaches and fellow wrestlers were the primary influence on weight loss methods; however, 40.2% indicated that the new NCAA rules deterred extreme weight loss behaviors. The primary methods of weight loss reported were gradual dieting (79.4%) and increased exercise (75.2%). However, 54.8% fasted, 27.6% used saunas, and 26.7% used rubber/plastic suits at least once a month. Cathartics and vomiting were seldom used to lose weight, and only 5 met three or more of the criteria for bulimia nervosa. WM behaviors were more extreme among freshmen, lighter weight classes, and Division II wrestlers. Compared to previous surveys of high school wrestlers, this cohort of wrestlers reported more extreme WM behaviors. However, compared to college wrestlers in the 1980s, weight loss behaviors were less extreme. CONCLUSIONS: The WM practices of college wrestlers appeared to have improved compared to wrestlers sampled previously. Forty percent of the wrestlers were influenced by the new NCAA rules and curbed their weight loss practices. Education is still needed, as some wrestlers are still engaging in dangerous WM methods.

Adolescent↗
PubMed1974

Laxative-induced diarrhoea: a continuing clinical problem.

Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.

Abdomen↗
PubMedDate not supplied

Effects of hyperosmolar agents--lactulose, lactitol, sodium phosphate and polyethylene glycol--on cecal coliform bacteria during traditional bowel cleansing: an experimental study in rats.

Mechanical bowel cleansing is considered to be necessary prior to colorectal surgery, some radiological or endoscopic procedures, and for fecal disimpaction. Traditional bowel cleansing (TBC) with cathartics and enemas is a method of mechanical bowel cleansing for patients who have restrictive factors for whole-bowel irrigation (WBI), such as excessive fecal impaction, cardiac, hepatic or renal disorders. In this experimental study, TBC with hyperosmolar agents was evaluated in terms of their effects on colonic flora and bacterial translocation (BT). Sprague-Dawley rats were divided into 6 groups. The animals, except controls, were not fed for 72 h but received tap water ad libitum. During this period, lactulose, lactitol, sodium phosphate (NaP), polyethylene glycol 3350 (PEG3350) and physiological saline gavages were administered to the rats in groups 1-5, respectively, once a day. All animals except controls (group 6) received enemas with 15 ml of warm saline twice a day. The cecum, mesenteric lymph nodes (MLNs) and portal vein blood were sampled for microbiological and histopathological analysis. The highest level of coliform bacterial overgrowth and BT to MLNs were observed in the lactulose group, although the others, except the saline and control groups, also caused some degree of BT. Portal vein cultures were negative for all groups. Histopathological damage was not associated with cecal bacterial count and BT. As a result of this study, PEG3350 seems to be safer and more effective than lactulose, lactitol and NaP during TBC.

Animals↗