Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy: a controlled study.
BACKGROUND
Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an alpha2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9+/-10.2 years, with a residual small bowel length of 71.8+/-152.0 cm that ended in a jejunostomy, were studied.


METHODS
Subjects were admitted to the North-western General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week.


RESULTS
Daily fecal volume and weight were 4.514+/-1.769 L/d and 4394+/-1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427+/-562 mL/d (8.9%, p=.07). Fecal weight decreased by 438+/-527 g/d (9.4%, p=.05). Urine volume correspondingly increased by 747+/-1934 mL (18.9%, p=not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r=-0.37 and -0.41, respectively, p=NS). Oral fluid intake decreased slightly from 3.328+/-1.246 L/d baseline to 3.203+/-1.119 L/d with clonidine therapy (-3.8%, p=NS). Fecal Na loss was significantly decreased from baseline (887+/-996 mg/d, 11.2+/-12.3%; p=.036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799+/-2.271 g/d) to 3.933+/-1.314 g/d after clonidine therapy (p=NS). No patient developed hypotension.


CONCLUSIONS
Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.
Buchman
Alan L
AL
Division of Gastroenterology, Northwestern Intestinal Rehabilitation Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. a-buchman@northwestern.edu
Fryer
Jon
J
Wallin
Anita
A
Ahn
Chul W
CW
Polensky
Sharon
S
Zaremba
Karen
K
D000279:Administration, Cutaneous; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy* / Q000378:metabolism; D005243:Feces / Q000737:chemistry; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D007582:Jejunostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012778:Short Bowel Syndrome / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D012964:Sodium / Q000378:metabolism* / Q000652:urine; D016896:Treatment Outcome; D016482:Urinalysis
D000316:Adrenergic alpha-Agonists; D012964:Sodium; D003000:Clonidine