Shirasawa Yuichi, Fukuda Michio, Kimura Genjiro
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University School of Medicine, 1 Kawasumi, Mizuho-Cho, Mizuho Ward, Nagoya City, Aichi Prefecture, 467-8601, Japan.
Asahi Rosai Hospital, Japan Labour Health and Welfare Organization, 61 Hirakocho-Kita, Owariasahi City, Aichi Prefecture, 488-8585, Japan.
CEN Case Rep. 2014 Nov;3(2):209-214. doi: 10.1007/s13730-014-0120-7. Epub 2014 Mar 26.
Hypopotassemia with acid-base imbalance caused by laxative abuse is one of the disorders that nephrologists can be consulted for. Although laxatives are not supposed to form psychological dependence in themselves and their abuse should be cured theoretically by just finishing the overdose, the patients often resist treatment due to unpleasant symptoms such as edema and worsening constipation. Thus, chronic laxative abuse is often regarded as a drug addiction. We report a successfully treated case of chronic laxative abuse, where drastic reduction of laxatives was achieved by applying diuretics. After drastic reduction of laxatives, diuretics were added until they eased edema and bloating so that the patient could feel them to be tolerable, paying attention to lab data such as potassium and renal function. The diuretics, which substituted for laxatives in fluid control, could be tapered off over 3 months without any withdrawal symptoms or a need of additional laxatives. Our experience of simple but successful treatment of chronic laxative abuse emphasizes importance of physical management and suggests that there are cases where the two different kinds of drugs, laxatives and diuretics, can practically be regarded as swappable in the treatment of laxative abuse. This presentation should contribute to accumulation of knowledge in how to treat chronic laxative abuse where no standardized method is established yet.
滥用泻药导致的低钾血症伴酸碱失衡是肾病科医生可提供咨询的病症之一。尽管泻药本身不应形成心理依赖，理论上过量服用问题只需停止即可治愈，但患者常因水肿和便秘加重等不适症状而抗拒治疗。因此，长期滥用泻药常被视为药物成瘾。我们报告一例成功治疗的慢性泻药滥用病例，通过使用利尿剂大幅减少了泻药用量。在大幅减少泻药用量后，添加利尿剂直至水肿和腹胀缓解，使患者能够耐受，同时关注钾和肾功能等实验室数据。在液体控制方面替代泻药的利尿剂可在3个月内逐渐减量，且无任何戒断症状，也无需额外使用泻药。我们对慢性泻药滥用进行简单而成功治疗的经验强调了身体管理的重要性，并表明在治疗泻药滥用时，泻药和利尿剂这两种不同药物在实际应用中可被视为可互换的。本报告应有助于在尚未建立标准化治疗方法的慢性泻药滥用治疗方面积累知识。
