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PubMedDate not supplied

Gastrointestinal decontamination in the emergency department.

Pediatric poisoning is a problem commonly encountered in the emergency department. After stabilization of airway, breathing, and circulation, one of the goals of treatment is decontamination in order to limit poison absorption and the resulting systemic toxicity. Decontamination modalities include gastric emptying (ipecac and gastric lavage), inhibiting absorption (activated charcoal), and catharsis (sorbital, magnesium citrate, and whole bowel irrigation). Each modality is discussed. Choice of modality by the practitioner must be individualized to each patient's situation.

Adolescent↗
PubMed1992

Bowel preparation for the total colonoscopy by 2,000 ml of balanced lavage solution (Golytely) and sennoside.

One of disadvantages of the Golytely preparation is that examinees have to drink as much as 4,000 ml of Golytely. To overcome this disadvantage, we designed a modified preparation regimen in which examinees have to drink only 2,000 ml of Golytely by taking sennoside orally. Bowel preparation was carried out in 297 examinees by this modified method. Examinees ate their usual diet and took 36 mg of sennoside orally on the night before the examination. On the day of the examination, the examinees drank a total of 2,000 ml of Golytely. No severe complications were noted and 97% of the examinees were able to drink the dose of 2,000 ml. Subjects who had also experienced bowel preparation by the modified method of Brown were asked to compare the two regimens, and only 1% preferred Brown's method while 73% preferred bowel preparation by our Golytely method. The result of bowel preparation by this method was excellent or good in 90 to 97% of the subjects at all sites in the colon and rectum. We conclude that bowel preparation for total colonoscopy using 2,000 ml of Golytely and sennoside is superior because it is highly acceptable to the examinees and provides excellent gut irrigation.

Adolescent↗
PubMedDate not supplied

Encopresis.

Encopresis is fecal soiling associated with functional constipation in a child. Constipation and encopresis are common problems in children. Encopresis is most common between ages 3 and 7 years. Infants and pre-school children present with a history of constipation and withholding maneuvers. The school-age child may have constipation and fecal soiling for some time prior to detection. In some children encopresis is associated with enuresis and urinary tract infection. Family education is the essential first step in management, followed by disimpaction of stool and complete evacuation of the rectum. Reaccumulation of stool should be prevented by appropriate use of laxatives and stool softeners. This is followed by a gradual weaning of the laxative regimen and instituting toilet training. Relapses may occur. Up to 50-60% of children achieve acceptable bowel control, free of soiling, within a year.

Age Factors↗
PubMedDate not supplied

Self-prescribed laxative use: a drug-utilization review.

This study was conducted to determine the reasons for the choice of self-prescribed laxatives and to acquire information on how they were used and tolerated. From November 1999 to February 2000, 70 pharmacies, uniformly located throughout the Campania region of southern Italy, distributed a questionnaire to purchasers of over-the-counter laxatives. The average age of the (mostly female) respondents was 45.9 years; 23.8% were elderly. Among the 7324 individuals who completed the survey, 77.6% selected an oral product; 22.4% preferred rectal administration. A physician influenced the choice of a laxative in 37.7% of the cases, a pharmacist in 20.5%; other suggestions came from relatives (14%), acquaintances (12.1%), advertisements (11.7%), and miscellaneous sources (4%). Only 59.8% of respondents used these drugs correctly, and 58.2% consulted a physician or pharmacist because of constipation. Adverse effects, mainly gastrointestinal symptoms, occurred in 6.1% of those surveyed. The long-term use or abuse of laxatives can cause serious medical consequences, as well as mask diseases, delaying diagnosis and appropriate treatment. Physicians, pharmacists, and other health-care personnel should counsel patients on the proper use of these easily available, ubiquitous drugs.

Adolescent↗
PubMed1998

Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis.

A model incorporating physiological, behavioral, and psychological parameters are presented to explain the maintenance and consequences of pediatric encopresis. It was hypothesized that the more comprehensive a treatment in addressing these parameters, the more efficacious it would be and the more children it would benefit. Eighty-seven children between the ages of 6 and 15 with the primary complaint of encopresis were randomly assigned to one of three treatments: (a) Intensive Medical Care (IMC), receiving enemas for disimpaction and laxatives to promote frequent bowel movements; (b) Enhanced Toilet Training (ETT), using reinforcement and scheduling to promote response to defecation urges and instruction and modeling to promote appropriate straining, along with laxatives and enemas; or (c) Biofeedback (BF), directed at relaxing the external anal sphincter during attempted defecation, along with toilet training, laxatives, and enemas. Three months following initiation of treatment, ETT and BF produced similar reductions in soiling/child (76% and 65%) that were superior (p's < .04) to IMC (21%). ETT significantly benefited more children than the other two treatments, employing fewer laxatives and fewer treatment sessions at a lower cost. Consistent with the presented model, reduction in soiling was associated with an increase in bowel movements in the toilet, reduction in parental prompting to use the toilet, and defecation pain. These results demonstrate that ETT should be used routinely with laxative therapy in the treatment of chronic encopresis.

Adolescent↗
PubMed2000

Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal.

This review summarizes the literature on randomized, controlled, published studies involving medical, behavioral, psychological, and biofeedback treatments for encopresis/functional constipation and stool-toileting refusal in preschool-age and school-age children. Nine such studies were located in the literature involving school-age children. No randomized, controlled treatment studies involving preschool-age children have been published. This review revealed no evidence to support the routine use of psychotherapy or anal sphincter biofeedback in the treatment of pediatric fecal elimination dysfunctions, beyond those benefits derived from a comprehensive medical-behavioral intervention. Further, this review indicated that paradoxical constriction of the External Anal Sphincter does not influence the treatment outcome of either biofeedback or medical-behavioral interventions. There are remarkably few controlled treatment outcome studies in this most important clinical area. More research is needed that employs standard treatment outcome variables.

Adolescent↗
PubMed2006

Constipation in children.

Constipation is a common problem throughout the world. It occurs in about 10-20% of adults in Western Countries and 0.3% to 28% of children worldwide. Most childhood constipation results from intentional withholding of stool following a painful experience with defecation. Thus, an extensive evaluation is often not necessary in a child presenting with constipation. Treatment should include education, evacuation of the rectum with oral or rectal laxatives if an impaction is present, laxatives to ensure soft stools and behavior modification.

Behavior Therapy↗
PubMed2006

Phosphate salt bowel preparation regimens alter perioperative acid-base and electrolyte balance.

BACKGROUND: Hyperphosphatemic acidosis and severe electrolyte disturbances caused by phosphate salts (PO) used for mechanical bowel preparation have been described in occasional case reports prior to bowel resection surgery. We hypothesized that PO used preoperatively for bowel preparation may cause more pronounced acid base and electrolyte changes than polyethylene glycol (PG). METHODS: Forty American Society of Anesthesiologists physical status II-III patients were randomly allocated to receive either PO or PG for bowel preparation before intra-abdominal surgery (bowel resection or other major elective intra-abdominal surgeries). Measurements of pH, base deficit, blood gases, lactate, hemoglobin, calcium, magnesium, potassium and phosphorus were undertaken before the laxative administration, intraoperatively, and postoperatively. RESULTS: Preoperative demographic, hemodynamic and laboratory data were similar in the two groups. Intraoperative calcium (8.4 [0.6] vs 9 [0.5] mg x dL(-1)) and pH (7.35 [0.04] vs 7.41 [0.03]) were lower, while lactate (1.3 [0.4] vs 0.9 [0.3] mmol x L(-1)) was higher with PO. Postoperative calcium, magnesium and potassium were lower (8 [0.5] vs 8.9 [0.2] mg x dL(-1), 1.68 [0.3] vs 1.8 [0.4] and 3.5 [0.36] vs 3.7 [0.33] mEq x L(-1) respectively) while phosphorus (4.1 [0.3] vs 3.3 [0.2] mEq x L(-1)) was higher with PO. A higher percentage of abnormal values for calcium, potassium, phosphorus and base deficit (66% vs 33%, 25% vs 10%, 19% vs 2% and 28.3% vs 5% respectively) were observed with PO. CONCLUSIONS: Calcium and magnesium changes were more pronounced in patients who received PO for bowel preparation.

Abdomen↗
PubMed1999

[Hypokalemic paralysis in furosemide therapy and simultaneous laxative abuse].

BACKGROUND: Clinical signs of hypokalemia are not directly related to the extent of the electrolyte imbalance, and therefore monosymptomatic cases may be observed. CASE REPORT: Following an acute gastroenteritis with considerable diarrhea, a 47-year-old male patient was admitted to hospital for progressive painful paraparesis. Upon admission, the patient complained of painful paresthesias in both legs, and a moderate flaccid paraparesis with widespread fasciculations and loss of leg tendon reflexes was found. Serum potassium level on admission was 1.7 mmol/l. Other signs of hypokalemia were absent, and the ECGs showed a slow sinus rhythm without disturbances of de- or repolarisation or cardiac arrhythmias. Hypokalemic paralysis was diagnosed and was considered to be primarily drug-induced, as the patient had a history of laxative abuse and was on a continuous medication with furosemide (80 mg/d) without regular assessment of serum electrolytes. The additional electrolyte loss following the gastroenteritis precipitated the development of clinical signs of hypokalemia. In parallel to the rise in serum potassium levels, both painful paresthesias and muscle weakness disappeared, and electromyography documented the amelioration of the myopathic syndrome. CONCLUSION: The prominent clinical symptom of hypokalemia was a dyskalemic paralysis in the absence of other sequelae of electrolyte imbalance, such as cardiac arrhythmias or vegetative disturbances.

Cathartics↗
PubMed1991

Study of constipation in a geriatric hospital, day hospital, old people's home and at home.

A study of constipation and related factors was carried out in 439 geriatric hospital patients, 183 people living in two old people's homes, and 78 patients visiting a geriatric day hospital. In addition, a cross-sectional survey of constipation and related factors was undertaken in 138 people older than 74 years and 74 people aged 41 to 50 years living at home. Constipation and the use of laxatives were most frequent in the geriatric hospital (79% and 76% respectively), followed by the old people's homes (59% and 60%), the day hospital (29% and 31%), elderly living at home (38% and 20%) and middle-aged living at home (12% and 5%). The results suggest an increased risk of constipation for the persons walking less than 0.5 km daily [relative risk (RR) = 1.7], walking with help (RR = 3.4), chairbound (RR = 6.9) and bedbound (RR = 15.9). The relative risk of constipation increased for the persons living in the old people's homes (RR = 1.7) and the geriatric hospital (RR = 2.2), and also with advancing age (between 75 and 84 years, RR = 2.9; over 84 years, RR = 4.9). The prevalence of constipation was directly correlated to fecal and urinary incontinence.

Adult↗
PubMed2003

Prevalence of abnormal eating behaviours and inappropriate methods of weight control in young women from Brazil: a population-based study.

OBJECTIVE: The aim of this epidemiological investigation was to study the prevalence of abnormal eating behaviours in a community sample of young women from Porto Alegre, RS, Brazil. METHODS: The research team visited 1524 randomly selected households in Porto Alegre and invited all of the women aged 12-29 years to participate in the study: 513 women subsequently completed a socio-economic and demographic questionnaire, the Bulimic Investigatory Test (BITE) and the Eating Attitudes Test (EAT-26). RESULTS: Clinically significant disturbed eating behaviour was revealed in the 16.5% of women who had EAT scores above the cut-off point of 21; 2.9% also had BITE symptom scores of > or = 20. The participants were categorised into three groups on the basis of a new variable combining both instruments: those with abnormal eating behaviours (10.9%), those with unusual eating patterns (23.8%), and those with normal eating behaviours (60.2%). Abnormal eating behaviours were significantly more prevalent in the 16-19 year age range (p = 0.007) and were also more prevalent among overweight/obese women (p = 0.009). Laxative use was reported by 8.5% of the women, followed by fasting (3.1%), use of diuretics (2.8%) and vomiting (1.4%). CONCLUSIONS: Abnormal eating behaviours are fairly common among young women in Brazil. In comparison with other population studies, this survey showed a similar use of laxatives, less self-induced vomiting and a greater use of diet pills (probably because they are less strictly controlled in Brazil). Educational programmes aimed at preventing abnormal eating behaviours and developing healthy weight control practices among children and young adolescents should become public health priorities.

Adolescent↗
PubMed2003

Binge eating behaviours, depression and weight control strategies.

The aim of this paper was to explore the relationships between depressive symptoms and weight control strategies in DSM-IV eating disordered patients with binge eating behaviours. We hypothesised that weight control strategies characterised by a loss of control, such as vomiting and purging, may be clinically associated with increased levels of depression. The study population consisted of 402 consecutive outpatients: 27 with binge eating/purging anorexia nervosa (AN-BN), 213 with purging bulimia nervosa (BN-P), 73 with non-purging bulimia nervosa (BN-NP), and 89 with binge eating disorder (BED). The severity of depression was measured using the Beck Depression Inventory (BDI), and binge eating behaviours were investigated using the self-report scale for bulimic behaviours. In the sample as a whole, the severity of depression significantly correlated with the severity of binge eating behaviours, but no significant differences were found in the severity of depression by diagnostic sub-types. In order to avoid the confounding erasing effect of time, a smaller sample of patients with a short history of binge eating behaviours was further explored. Furthermore, because weight control strategies and the eating disorder diagnostic sub-types overlapped imperfectly, the patients were compared on the basis of presence or absence of strategies reflecting an active attempt to master the weight gain due to bingeing behaviours. The patients adopting active control strategies (N = 14) had significantly less severe depressive symptoms than those adopting non-active weight control strategies (N = 39). Finally, the Authors discuss some hypotheses concerning the defensive role of weight control strategies and the impact of illness duration on the clinical expression of depression in eating disordered patients.

Adult↗