title: Laxative-induced rhabdomyolysis.
abstract: The present study describes a case of laxative-induced rhabdomyolysis in an elderly patient. An 87-year-old woman was hospitalized for the onset of confusion, tremors, an inability to walk, and a fever that she had been experiencing for 36 hours. She often took high dosages of lactulose and sorbitol syrup as a laxative (about 70 g/day). During her physical examination, the patient was confused, drowsy, and she presented hyposthenia in her upper and lower limbs, symmetric and diffuse moderate hyporeflexia, and her temperature was 37.8 degrees C. Laboratory tests revealed severe hyponatremia with hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis. Moreover, rhabdomyolysis markers were found. The correction of hydroelectrolytic imbalances with saline, potassium and sodium chlorure, calcium gluconate was the first treatment. During her hospitalization the patient presented acute delirium, treated with haloperidol and prometazine chloridrate intramuscularly. She was discharged 12 days later, after resolution of symptoms, and normalized laboratory tests. Over-the-counter drugs such as laxatives are usually not considered dangerous; on the other hand, they may cause serum electrolytic imbalance and rhabdomyolysis. A careful monitoring of all the drugs taken by the elderly is one of the most important duties of a physician since drug interactions and their secondary effects may be fatal.
authors.affiliation: Geriatrist, Geriatric Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Merante
authors.forename: Pietro
authors.initials: P
authors.lastname: Gareri
authors.forename: Norma Maria
authors.initials: NM
authors.lastname: Marigliano
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Fazio
authors.forename: Elvira
authors.initials: E
authors.lastname: Bonacci
authors.forename: Carlo
authors.initials: C
authors.lastname: Torchia
authors.forename: Gaetano
authors.initials: G
authors.lastname: Russo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lacroce
authors.forename: Roberto
authors.initials: R
authors.lastname: Lacava
authors.forename: Alberto
authors.initials: A
authors.lastname: Castagna
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruotolo
mesh_terms: D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage / Q000009:adverse effects*; D004366:Nonprescription Drugs / Q000009:adverse effects; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D054368:Laxatives; D004366:Nonprescription Drugs
references.citation: Can Med Assoc J. 1982 Apr 1;126(7):780-2
references.pmid: 7074473
references.citation: Clin Pharmacol Ther. 1981 Aug;30(2):239-45
references.pmid: 7249508
references.citation: JAMA. 2008 Dec 24;300(24):2867-78
references.pmid: 19109115
references.citation: Am J Clin Nutr. 2005 Jun;81(6):1342-50
references.pmid: 15941885
references.citation: J Neurol Neurosurg Psychiatry. 2003 Jun;74 Suppl 2:ii3-ii8
references.pmid: 12754322
references.citation: Crit Care. 2005 Apr;9(2):158-69
references.pmid: 15774072
references.citation: J Natl Med Assoc. 1987 Oct;79(10):1033-8
references.pmid: 3316670
references.citation: J Natl Med Assoc. 2005 Feb;97(2):217-24
references.pmid: 15712785
references.citation: BMJ. 2007 Apr 21;334(7598):842-6
references.pmid: 17446616