Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
J Adolesc Health. 2024 Feb;74(2):392-394. doi: 10.1016/j.jadohealth.2023.08.052. Epub 2023 Oct 15.
Loperamide, an oral over-the-counter μ-opioid receptor agonist used to treat diarrhea, acts primarily in the gut and, when used as recommended, has little to no systemic effect. At high doses, it may cause a "high" like other opioids. Recent literature describes an increasing incidence of loperamide misuse and overdose in the setting of the US opioid epidemic. In this case, we describe a 16-year-old with anorexia nervosa who developed dizziness, syncope, and constipation at the time of weight loss. These symptoms were originally attributed to malnutrition; however, after weight restoration, her symptoms worsened. She did not respond to initial management of suspected postural orthostatic tachycardia syndrome (POTS). She then developed acute urinary retention requiring hospitalization. Her symptoms were ultimately found to be caused by chronic surreptitious high-dose loperamide use. Her symptoms rapidly improved after cessation. This case illustrates the non-specific symptoms associated with loperamide misuse and the potential overlap with other common adolescent conditions. Adolescent medicine clinicians must be aware of the signs and symptoms of loperamide misuse as well as familiar with recommendations for both the management of acute complications and the treatment of the substance misuse.
洛哌丁胺是一种口服的、非处方的 μ 阿片受体激动剂，用于治疗腹泻，主要在肠道起作用，按推荐剂量使用时，几乎没有全身作用。高剂量时，它可能会像其他阿片类药物一样引起“快感”。最近的文献描述了在美国阿片类药物流行的背景下，洛哌丁胺的滥用和过量使用的发生率不断增加。在本例中，我们描述了一位患有神经性厌食症的 16 岁女孩，在减肥时出现头晕、晕厥和便秘。这些症状最初归因于营养不良；然而，在体重恢复后，她的症状恶化了。她对疑似体位性心动过速综合征（POTS）的初始治疗没有反应。然后她发展为急性尿潴留，需要住院治疗。她的症状最终被发现是由慢性秘密高剂量洛哌丁胺使用引起的。停药后，她的症状迅速改善。本病例说明了与洛哌丁胺滥用相关的非特异性症状，以及与其他常见青少年疾病的潜在重叠。青少年医学临床医生必须意识到洛哌丁胺滥用的迹象和症状，以及熟悉急性并发症的管理和物质滥用的治疗建议。
