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Colonic irrigations: a review of the historical controversy and the potential for adverse effects.

Colonic irrigations enjoy widespread popularity among alternative medicine practitioners, although they are viewed with considerable skepticism by the conventional medical community. Although proponents make claims of substantial health benefits, skeptics cite the lack of evidence for health benefits and emphasize the potential for adverse effects. Yet historically, there are clinical reports of effectiveness and virtually no research refuting these reports. Instead there was a campaign against exaggerated claims by nonmedical practitioners that resulted in a movement away from this form of therapy without any scientific study of efficacy. Given the current popularity of colonic irrigations, it is important that such research be performed, which will require a quantitative estimate of the potential for adverse effects. Although there is little specific literature on colonic irrigations, a review of the literature on related procedures such as enemas and sigmoidoscopies suggests that the risk of serious adverse effects is very low when the irrigations are performed by trained personnel using appropriate equipment.

Constipation↗

Cellular toxicity of fecal water depends on diet.

To determine whether concentrations of potentially toxic lipids in the aqueous phase of human stool are responsive to changes in dietary fat, calcium, and fiber, 20 male volunteers were placed on a high-fat, low-calcium, low-fiber or a low-fat, high-calcium, high-fiber diet for 4 days. To assess toxicity of the fecal fractions, we examined the ability of fecal supernatants to lyse human erythrocytes. Bile acid concentrations in fecal water from the low-fat group were reduced significantly from 180 +/- 60 microM to 100 +/- 70 microM; in the high-fat group, increased from 190 +/- 60 microM to 250 +/- 100 microM. Erythrocyte lysis was 76% for the high-fat group, 37% for the low-fat group. There was a significant weak correlation between aqueous bile acid concentration and cell lysis. Results suggest that diet can influence concentrations of detergents in the aqueous phase of human stool and the potential toxicity of this fraction to cell membranes.

Adult↗

Association between preference for sweets and excessive alcohol intake: a review of animal and human studies.

This report reviews a series of studies demonstrating a relationship between the consumption of sweets and alcohol consumption. There is consistent evidence linking the consumption of sweets to alcohol intake in both animals and humans, and there are indications that this relationship may be at least partially genetic in nature. Alcohol-preferring rats have a tendency to consume sucrose and saccharin solutions far beyond the limits of their normal fluid intake and this has been proposed to be a model of the clinical phenomenon known as loss of control. Furthermore, rats and mice, genetically bred to prefer alcohol, tend to choose more concentrated sweet solutions, compared to animals which do not prefer alcohol. Similar tendencies to prefer ultra-sweet solutions have been noted in studies of alcoholic subjects, with most alcoholics preferring sweeter sucrose solutions than do controls. Evidence also exists that those alcoholics who prefer sweeter solutions may represent a familial form of alcoholism. Finally, consumption of sweets and/or sweet solutions may significantly suppress alcohol intake in both animals and in alcoholics. Carbohydrate structure and sweet taste may contribute to this effect through different physiological mechanisms involving serotonergic, opioid, and dopaminergic functions. The possibility that there is concordance between sweet liking and alcohol consumption and/or alcoholism has theoretical, biological, and diagnostic/practical implications.

Alcohol Drinking↗

Pharmacologic activities of aged garlic extract in comparison with other garlic preparations.

We investigated the pharmacologic activities of four garlic preparations, raw garlic juice (RGJ), heated garlic juice (HGJ), dehydrated garlic powder (DGP) and aged garlic extract (AGE). The study used three animal models, i.e., testicular hypogonadism (hypospermatogensis and impotence) induced by warm water treatment, intoxication of acetaldehyde and growth of inoculated tumor cells. RGJ was found to be effective only in recovery of testicular function. The efficacy of HGJ was observed in three models; however, it did not improve impotence. DGP was effective in recovery of spermatogenesis and stimulated acetaldehyde detoxification. Significant beneficial effects of AGE were found in all three models. Although all four garlic preparations significantly enhanced natural killer (NK) and killer cell activities of the spleen cells of tumor-bearing mice, only AGE and HGJ inhibited the growth of inoculated tumor cells. These results suggest that different types of garlic preparations have different pharmacologic properties, and among the four garlic preparations studied, AGE could be the most useful garlic preparation.

Acetaldehyde↗

Ibuprofen induced hyponatraemia.

A 55-year-old woman in an advanced stage of chronic renal failure due to pyelonephritis developed severe hyponatraemia after receiving 400 mg/day of ibuprofen for 3 days. The typical symptoms and the hyponatraemia disappeared when the drug was withdrawn. The likely mechanism involved and the clinical implications are discussed.

Female↗

Multidisciplinary approach to psychosis, intermittent hyponatremia, and polydipsia.

The syndrome of psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome), seen in the seriously mentally ill, can result in severe biopsychosocial impairment, including an excessive death rate if not identified early. Because of its impact on the health, functioning, and quality of life of the seriously mentally ill patient, all mental health care providers must be aware of the signs and symptoms of PIP syndrome. Physiological, psychological, behavioral, self-care, and social factors all play a role in the manifestation of the syndrome; it follows that a multidisciplinary approach is crucial to ensure early detection, monitoring, and treatment of this problem both in the hospital and in the community. This article explains how we have incorporated the strengths of various disciplinary strategies into a unified treatment model for managing PIP syndrome and its sequelae.

Combined Modality Therapy↗

Case report: hyponatremia associated with nonsteroidal antiinflammatory drugs.

The effects of renal prostaglandins on medullary blood flow, active chloride transport, and antidiuretic hormone are important in urine dilution. It is surprising, therefore, that drugs that inhibit prostaglandin synthesis rarely cause hyponatremia. A patient in whom hyponatremia developed during ibuprofen administration is described and other reported cases of this association in adults are reviewed. The previous case reports fall into two well defined groups: first, neonates treated with indomethacin for patent ductus, and second, adults, often elderly, who usually have other diseases that impair urinary dilution. Although hyponatremia is a rare consequence of therapy with prostaglandin inhibitors, certain individuals are at increased risk and should be monitored for this side effect.

Aged↗

The urine/plasma electrolyte ratio: a predictive guide to water restriction.

Patients with hypotonic hyponatremia are encountered commonly in the general practice of medicine. Nearly all strategies for the management of subacute or chronic hyponatremia call for some amount of water restriction. The considerations for such a prescription have not been addressed in the literature. We describe therefore a simple approach grounded in the physiology of electrolyte-free water clearance that can be used at the bedside.

Electrolytes↗

Developing a best practice model for care of patients with polydipsia.

Some psychiatric patients diagnosed with schizophrenia have a secondary diagnosis of polydipsia which is manifested by consuming excessive quantities of fluids, marked confusion, and disorientation. In most instances, these persons are less amenable to treatment and rehabilitative interventions due to the changes in cognitive and physical processes. A review of our own current practice found that we had a small group of polydipsia patients requiring a large amount of one-to-one staff time for little or no long-term benefit. Further, there was no uniform approach to identify, treat, and monitor outcomes for patients with polydipsia. A TQM team was assembled with the goal of identifying a protocol for assessing the presence of polydipsia and a care map for the treatment of confirmed cases. The outcome was the development of a care map using diagnostic procedures and interventions found in the professional literature and empirical data collected on site. A short pilot study revealed that a number of polydipsia patients on Clozaril along with other interventions were successfully discharged from the hospital.

Antipsychotic Agents↗