Jejunal ulceration and stricture due to wax-matrix potassium chloride tablets and amitriptyline.
A 68-year-old woman presented with abdominal distention of several weeks duration and an acute small bowel obstruction. For several years she had been prescribed amitriptyline 150 mg/d, L-thyroxine 100 micrograms/d, and digoxin 0.25 mg/d. For the previous year she had been taking hydrochlorothiazide 50 mg/d and wax-matrix KCl 20 mEq/d for hypertension. At surgery a "napkin-ring" stricture of the midjejunum was found. It had microscopic features consistent with KCl local toxicity. It is speculated that delayed gastrointestinal motility secondary to amitriptyline predisposed this patient to wax-matrix KCl toxicity and that this potential side effect be considered when prescribing wax-matrix KCl.
Bronson
D L
DL
Department of Medicine, University of Vermont College of Medicine, Burlington.
Gamelli
R L
RL
D000368:Aged; D000639:Amitriptyline / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007579:Jejunal Diseases / Q000209:etiology*; D011189:Potassium Chloride / Q000008:administration & dosage / Q000009:adverse effects*; D014456:Ulcer / Q000209:etiology*; D014885:Waxes
D003692:Delayed-Action Preparations; D014885:Waxes; D000639:Amitriptyline; D011189:Potassium Chloride