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PubMed2003

[A case of mixed poisoning by organophosphate and methanol].

We encountered a case of mixed poisoning by organophosphate and methanol. Each poisoning was comparatively frequent but we reviewed no cases of mixed poisoning of them. A 49-year-old woman was transferred to our hospital because of oral ingestion of organophosphorous compound (about 14 g of fenitrothion) and glass cleaner (about 40 g of methanol) for suicidal purpose. She underwent general antioverdose treatment including gastric lavage, activated charcoal and cathartics. For fenitrothion poisoning, she received atropine and pralidoxime. For methanol poisoning, she was treated with hemodialysis. Three days later, she moved to psychiatric ward from emergency ward without aftereffects and was given a diagnosis of depression.

Cathartics↗
PubMed2004

[A case of acute encephalopathy due to datura seed poisoning].

A 83 year-old-man presented with a stuporous state. He ingested datura seeds approximately 1.5 hour before the onset of the symptom. On arrival at our emergency clinic 2 hours and 40 minutes after the ingestion, he was semi-comatose with intermittent tonic convulsive seizures. The pupils were fully-dilated and unreactive, and salivation was decreased. He showed hypohidrosis and exaggerated deep tendon reflexes with positive Babinski's sign. His body temperature was 37.6 degrees C, and blood pressure was 167/99 mmHg. After gastrolavage and administration of charcoal and cathartics, his pupil became reactive to light, and he became alert gradually. His consciousness became clear 24 hours after seed ingestion and discharged with no residual neurological signs.

Acute Disease↗
PubMed2004

[Chronic constipations in elderly people].

Chronic constipations in elderly people proved to be an important medical and social problem due to their high prevalence and serious complications caused by the very disease and administration of stimulating laxatives. They include as follows: anorectic incontinence, large intestine obstruction, stercoral ulcers, laxative dependence and bowels toxic affection (Cathartic colon). Morphological and physiological prerequisites of chronic constipation and anorectic incontinence occurrence are examined in this review. Drugs and tactics for monitoring constipations depending on their severity, dominance of transit and evacuation disturbances, occurrence of anorectic incontinence are described. Characteristics of laxatives and intestinal motility regulators, range of side effects as well as experience of their application in elderly patients with functional constipations and irritable bowel syndrome are presented.

Aged↗
PubMed2006

Lipoid pneumonia: a preventable complication.

BACKGROUND: Lipoid pneumonia is a pneumonitis resulting from the aspiration of lipids, and is commonly associated with the use of mineral oil as a laxative. LP is relatively unfamiliar to clinicians and is probably underdiagnosed. OBJECTIVES: To increase physicians' awareness of LP, its diagnosis and prevention. METHODS: We present two illustrative cases of LP and review the literature. RESULTS: Two cases of LP were diagnosed within half a year in an internal medicine ward. Both cases were elderly patients, and LP was associated with the use of mineral oil as a laxative agent. Computerized tomography revealed bilateral low attenuation infiltrates, associated with a "crazy paving" pattern in one case. Sudan Black staining was diagnostic in both cases--in one on a transbronchial biopsy specimen, and in the other on sputum cytologic examination. Both patients suffered from neurologic diseases and were at risk of aspiration. In both cases clinical symptoms and signs continued for several months prior to diagnosis but resolved after the mineral oil was discontinued. CONCLUSIONS: LP often occurs in elderly patients who are at risk of aspiration. The condition may be underdiagnosed. Since in most cases mineral oil cathartics are the causative agent, an effort at primary prevention is indicated. It is suggested that the licensing of mineral oil for internal use be changed.

Aged↗
PubMedDate not supplied

[Preparation of the colon for endoscopic examinations. A clinical study].

The paper gives a short critical bibliographic review of colonic preparation for endoscopy, focusing on the out-patient use of gastrointestinal endoscopy. A method of preparation based on dietary restrictions plus cathartics is proposed that allows the number of enemas used to be reduced to a minimum. The results obtained in 265 out-patients undergoing colonoscopy confirm the efficacy, practicality and tolerability of the method.

Adolescent↗
PubMed1989

[Comparative evaluation of a new colon preparation method prior to a double-contrast barium enema: toward discontinuation of the cleansing enema].

Evaluation of the efficacy and adequacy for double contrast barium enema of a recently described oral lavage solution associated with bisacodyl (Prepacol) and its comparison with a traditional method of colon cleansing (low-residue diet, cathartics and water enema) are reported. Two similar groups of 100 outpatients were compared. The new cleansing method presents several interesting advantages: time saving for the nurse of the radiology department and the patient himself (cleansing enema is no longer required), better patient acceptance, equal evacuation of fecal residue but significantly better evacuation of residual liquid resulting in better mucosal coating.

Adult↗
PubMed1989

[Abuse of laxatives as the cause of obscure prolonged diarrhea].

Although concealed abuse of cathartic laxatives is probably an unusual cause of severe longstanding diarrhoea, nevertheless, it is presumably a more frequent cause of such diarrhoea than are endocrine pancreatic tumours. The patient often undergoes extensive and expensive investigations before the diagnosis can be reached if indeed it ever is. The condition is almost exclusive to women, often those employed in medical care. A psychiatric background is usual, frequently with anorectic traits. The abuse often continues even after 'disclosure' and commonly defies psychotherapy.

Adult↗
PubMed1986

Factitious diarrhoea.

Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.

Adult↗
PubMed1986

Effect of magnesium citrate on the adsorptive capacity of activated charcoal for sodium salicylate.

The effects of an added saline cathartic (magnesium citrate) on the in vitro adsorption of sodium salicylate by activated charcoal were determined at different pH levels. At low pH added magnesium citrate reduced salicylate adsorption. However, at high pH added magnesium citrate enhanced adsorption. These results indicate that magnesium citrate should have no detrimental effect on the action of activated charcoal in vivo. Indeed, a slight beneficial effect is suggested by this and other studies.

Adsorption↗
PubMed1979

Increased survival in experimental dog heatstroke after reduction of gut flora.

A study was undertaken to determine if gut flora contribute to the pathophysiology of experimental canine heatstroke. Fifty animals in four groups were anesthetized with sodium pentobarbital (25 mg/kg) intravenously. An air temperature of 42-46 degrees C was maintained adjacent to the dog with a water-heated blanket for approximately 2 h until rectal temperatures rose to 43.5 +/- 0.4 degrees C. Animals were then cooled passively in room air (28 degrees C, 20% RH) until death or until 18 h elapsed, and were euthanized. Reduction of intestine stool and bacterial contents with antibiotics, cathartics, and enemas prior to heatstroke increased the incidence of 18-h survival from 20.0% to 70.6%; antibiotics administered after heatstroke did not alter the incidence of survival over control values. These data suggest that gut flora, presumably through endotoxemia, contribute to the evolution of heatstroke pathophysiology.

Animals↗
PubMed1977

[Azapropazone plasma levels under simultaneous treatment with an antacid or laxative].

Azapropazone is a non-steroid antirheumatic drug, commonly used in long-term treatment of inflammatory and non-inflammatory rheumatic diseases. Since antacids and laxatives are often taken simultaneously the present study was concerned with the influence of a concomitant treatment with medium doses of dihydroxy-aluminium sodium carbonate, magnesium aluminum silicate, bisacodyl and anthraquinone cathartics on steady-state plasma levels of azapropazone when azapropazone was given as an oral dose 3 times daily to 15 patients. Azapropazone plasma levels were determined 5 h after azapropazone administration by a direct quantitative thin-layer chromatographic method. Azapropazone plasma levels during simultaneous treatment with antacids were 70.3 +/- 14.1 microgram/ml in comparison to 75.4 +/- 16.5 microgram/ml after azapropazone alone (p = 0.10). After the administration of the laxatives a mean plasma concentration of 68.2 +/- 10.1 microgram/ml was obtained, without laxative the average plasma level of azapropazone accounted for 65.1 +/- 8.1 microgram/ml (p greater than 0.05). There were virtually no effects of simultaneous treatment on azapropazone plasma levels. The results suggest that azapropazone can be given together with antacids and laxatives since there is no significant interaction.

Adult↗
PubMed1984

Complications of hazardous weight-loss methods.

Individuals who are overly conscious of their weight and those with eating disorders may induce vomiting and abuse laxatives and diuretics in order to lose weight. Self-induced vomiting may result in dental erosion, parotid and submandibular gland enlargement, oral and perioral trauma, pharyngeal and esophageal inflammation, aspiration and esophageal-gastric tears. Laxative abuse leads to digestive system complications such as cathartic colon and melanosis coli. All three purging methods lead to dehydration and electrolyte disturbances.

Body Weight↗
PubMed1984

Gastrointestinal decontamination in the management of the poisoned patient.

Ipecac syrup is the agent of choice to promote emesis in awake, alert, and cooperative patients who have ingested poison. Lavage is a reasonable alternative when ipecac fails or emesis is contraindicated. Activated charcoal is effective in minimizing absorption of ingested toxins, and saline cathartics may be useful to hasten the elimination of activated charcoal and possibly of enteric-coated or sustained release medications.

Animals↗
PubMed1981

A screening method for establishing laxative abuse.

Abuse of laxatives, most of them belonging to the group of colonic stimulants or cathartics, can cause various disorders. Extensive diagnostic work can be avoided by early toxicological screening of the suspected patients with respect to laxatives. Because no screening method of this kind was available, we developed a procedure with which all phenolic and anthraquinone laxatives--except sodium picosulfate--can be detected in urine. This method is based on high-performance thin-layer chromatography in two systems after pretreatment of a 20-mL urine sample with beta-glucuronidase and subsequent column extraction. The procedure is very sensitive: at least 32 h after a single dose of bisacodyl, danthron, phenolphthalein, or sennoside, the drug can be detected in the urine. Bisoxatin and oxyphenisatin are still detectable in the urine 18 h after intake. The method is also highly specific; none of 73 other drugs interfered in either of the two chromatographic systems. This procedure can be helpful for the early diagnosis of laxative abuse.

Adult↗
PubMed1980

Laxative abuse syndrome.

Laxative abuse syndrome (LAS) is a type of Münchausen syndrome characterized by surreptitious abuse of purgatives. Clinical findings are often perplexing and may mimic inflammatory bowel disease or malabsorption syndromes. Patients frequently complain of diarrhea alternating with constipation and may have nausea, vomiting and weight loss. Psychiatric disturbances are common and may include anorexia nervosa. Melanosis coli and cathartic colon, acid-base disturbances (usually metabolic alkalosis), sodium, potassium and water depletion, hyperuricemia, hyperaldosteronism and other electrolyte changes are possible complications. Diagnosis may be extremely difficult and may require special chemical analysis of urine and feces and search of the patient's possessions. Treatment is frustrating because the patient is rarely willing to admit to laxative abuse let alone cooperate in attempting to stop it. Physicians must be aware of the LAS in order to avoid harming the patient with extensive, expensive and often invasive (including laparotomy) procedures.

Acid-Base Imbalance↗
PubMed1980

Hypernatremia in hepatic failure.

The presence of hypernatremia in patients with hepatic failure has not received major attention. We examined the records of 25 patients admitted to the hospital with decompensated liver disease (usually Laënnec's cirrhosis) and found hypernatremia in 15. Probable causes include increased insensible water losses, impairment of water intake due to encephalopathy, and the use of osmotic cathartics with hypotonic enteric losses. Patients in this series showing hypernatremia had a mortality of 87%. Mortality in those without hypernatremia was 60%. The presence of increased serum sodium concentrations in patients with decompensated liver disease is an ominous but correctable abnormality reflecting a disturbance in water balance.

Adult↗
PubMed1980

Meconium ileus equivalent: treatment with Hypaque enema.

Meconium ileus equivalent is an unusual cause of intestinal obstruction in adults. In this paper we report of our experience with a 29-year-old male with a long-standing history of cystic fibrosis and recurrent abdominal pain. Following barium examination of the stomach and small bowel, the patient developed increasing abdominal pain and evidence of meconium ileus equivalent as the etiology of his small bowel obstruction. The obstruction was relieved by administration of a 20% sodium diatrizoate enema and oral saline cathartics. The clinical and radiographic findings of meconium ileus equivalent are reviewed, as is the use of water-soluble contrast agents in the management of this condition. The role of prior barium study in precipitating this condition is discussed.

Cathartics↗
PubMed1995

Mechanical bowel preparation in review.

Mechanical bowel preparation is necessary for colorectal surgery, colonoscopy, and diagnostic radiological studies. While the techniques of bowel cleansing employed for each of these procedures are similar, indication-specific methods of preparation vary. Peroral lavage, traditional cathartics and enemas, and per-rectal lavage are discussed in this overview.

Cathartics↗