Department of Chemistry, Seattle Children's and University of Washington School of Medicine, Seattle, USA.
J Pediatr Gastroenterol Nutr. 2010 Mar;50(3):276-9. doi: 10.1097/MPG.0b013e3181a9375a.
The ability to test stool for laxatives is an important part of patient care in some clinical circumstances. Some patients take or are given laxatives surreptitiously. Additionally, failure to take prescribed laxatives may result in treatment failure in children with constipation or encopresis. Although laboratory methods have been available to identify many laxatives in the stool, tests are not available for detecting polyethylene glycol (PEG)-based laxatives. PEG-based laxatives are frequently used in the treatment of children with constipation. We developed a mass spectrometry (MS)-based analysis for detecting PEG in stool and verified the technique in an adult volunteer. We then piloted the assay on stools from children taking PEG for constipation versus children with diarrhea who were not taking PEG. Eleven subjects with diarrhea and 8 receiving PEG were enrolled. Nine of the children with diarrhea and 7 receiving PEG were evaluated by MS. All 3 subjects with PEG who had a stool osmolal gap determined had elevated gaps. Stools of all 7 subjects with PEG were positive for PEG by MS, whereas none of the 9 subjects with diarrhea had stool positive for PEG. This new MS methodology to test stool for PEG is described. It is likely to prove useful in the documentation of surreptitious PEG administration and in evaluation of PEG treatment failure.
检测粪便中是否含有通便剂是某些临床情况下患者护理的重要组成部分。有些患者会偷偷服用或被给予通便剂。此外，便秘或大便失禁的儿童如果未能服用规定剂量的通便剂，可能会导致治疗失败。虽然已经有实验室方法可以鉴定粪便中的许多通便剂，但无法检测到基于聚乙二醇（PEG）的通便剂。基于 PEG 的通便剂常用于治疗便秘的儿童。我们开发了一种基于质谱（MS）的方法来检测粪便中的 PEG，并在成年志愿者中验证了该技术。然后，我们在接受 PEG 治疗便秘的儿童和未接受 PEG 治疗腹泻的儿童的粪便上进行了检测。共有 11 名腹泻和 8 名接受 PEG 的儿童参与了该试验。9 名腹泻儿童和 7 名接受 PEG 的儿童接受了 MS 评估。所有 3 名接受 PEG 治疗且渗透压间隙确定的患者的间隙均升高。MS 检测到所有 7 名接受 PEG 治疗的患者的粪便中均含有 PEG，而 9 名腹泻患者的粪便中均未检测到 PEG。本文描述了一种用于检测粪便中 PEG 的新 MS 方法。该方法可能有助于证明隐匿性 PEG 给药的存在，并有助于评估 PEG 治疗失败。
