Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Laryngotracheitis Laxative Abuse 885

complications and prognosis

■Obstruction can become progressive and lead to severe respiratory

distress with hypoxia.

■May predispose to hyperreactive airways later in life

LAXATIVE ABUSE

MARTA L. DAVILA, MD

history & physical

■Possible presentations: diarrhea, abdominal discomfort, nausea,

vomiting, weight loss, muscle weakness, bone pain, rectal pain and

lassitude

■Laxative abuse present in 4–15% of patients with chronic diarrhea

■Most patients women with an altered self-image, often with anorexia

or bulimia nervosa

■Other patients with hysteria-like characteristics in the absence of a

motive for gain

■Chronic stimulant laxative abuse (>15 years) may result in cathartic

colon, which can present with constipation and vague abdominal

discomfort rather than diarrhea

■Admission of laxative use unusual, unless confronted with evidence

■Signs: skin pigmentation, cyclic edema, kidney stones, clubbing

tests

Basic Tests: Blood

■Electrolytes (hypokalemia, metabolic alkalosis)

Diagnostic Tests:

■Stool for osmolarity and electrolytes

➣High fecal sodium with a low fecal chloride concentration suggest

sodium sulfate or sodium phosphate ingestion

➣Osmotic diarrhea suggests magnesium laxatives

■Stool or urine for phenolphtalein

➣3 ml of stool supernate or urine mixed with one drop of one

normal (1N) sodium hydroxide; pink or red color indicates phe-

nolphtalein is present

■Stool or urine for emetine, bisacodyl and its metabolites, and

anthraquinone derivatives