Electrolyte losses associated with the taking of purges investigated with aid of sodium and potassium radioisotopes

Abuse of drugs associated with eating disorders

Concomitant bulimia nervosa and drug abuse are common in women. Drugs used by this group include diuretics, emetics, laxatives, and diet pills, as well as alcohol, cigarettes, and illicit street drugs. This paper applies principles from behavioral pharmacology to the problem of drug use by women with bulimia nervosa. The prevalence of use, primary effects, toxicity, detection, tolerance, withdrawal, and effects on appetite and weight are discussed for drugs used by bulimic women to reduce appetite or weight or to induce purging (e.g., diuretics, emetics, laxatives, and diet aids). Alternatives in the diagnosis and treatment of drug use in women with eating disorders are discussed.

In vitro effects of gastrin on the movement of electrolytes across the human colon

Using an in vitro system, the effect of gastrin on the colonic handling of water and electrolytes has been investigated. Gastrin converted the normal mucosal absorption of water and sodium into a net secretion. The colonic response to gastrin was done-related with respect to sodium, and the effects were greater when it was added to the serosal side. The potassium handling of the isolated colonic mucosa was not altered by gastrin. At a concentration of 800pg/ml, gastrin signficantly reduced the normal movement of sodium from mucosa to serosa (absorption) but significantly increased serosal to mucosal movement (secretion). This alteration in the bidirectional flux of ions under the influence of gastrin may be clinically important and could account in partt for the diarrhoea associated with the Zollinger-Ellison syndrome.

Laxative-induced diarrhoea: a continuing clinical problem

Seven women spent an average of 127 days in hospital and were extensively investigated, including a laparotomy, before their complaints of abdominal pain, diarrhoea, and weight loss were shown to be due to excessive taking of laxatives. All denied taking laxatives and in none were the characteristic features of the effects of cathartics on the colon seen on sigmoidoscopy or radiological examination.Hypokalaemia and other electrolyte abnormalities were common and were thought to be due to a combination of severe diarrhoea and vomiting. The rectal mucosa was seen to be abnormal on biopsy only in the three patients who had taken senna preparations. The diagnosis was not easy and was finally established either by analysis of the urine and stools or by searching the patient's ward locker.

An unusual case of self-induced electrolyte depletion

A case of anorexia nervosa, presenting with unexplained hypokalaemia, is described. The patient was also secretly addicted to purgatives and diuretics. During an attempted metabolic balance study she secretly disposed of food and excreta, which were smuggled from the hospital by her sister. The patient induced her husband to bring his own stools into the ward, these then being substituted for her own. The interrelationships of the electrolyte disturbances, elevation of plasma renin, renin substrate, and hyperaldosteronism are discussed, particularly in connexion with the pathogenesis of peripheral oedema in anorexia nervosa.

Syndromes of water and electrolyte depletion of intestinal origin

Because of the important part played by the intestine in maintaining the constancy of the internal environment, any disturbance in the orderly sequence of secretion and reabsorption of water and electrolytes can quickly lead to severe fluid depletion. Malabsorption of water and electrolytes may occur in diseases of the intestinal mucosa or following massive resection of bowel or as a result of disordered intestinal motility. The handling of fluids by the bowel may be altered by the action of hormones or of bacterial toxins, or in the presence of neoplasms. Electrolyte disorders may result from the introduction of abnormal solutions into the intestinal lumen.

Management of the clinical problems requires a clear understanding of the abnormal mechanisms and urgent attention to the re-institution of water and salt balance, restoration of acid-base status and replacement of lost potassium.

The treatment of constipation in mental hospitals

This study investigates the incidence of constipation in two representative mental institutions, and the effect, in one of the hospitals, of restricting the use of laxatives to only one drug, namely, standardized senna (Senokot). The remarkable potentiality of Senokot for long-term re-educative programmes is reflected in the reduction from 44% of 210 patients receiving various laxatives regularly at the start of the trial to 8% after three months' treatment. The special studies showed that chronic psychotics could be freed from enemas and a substantial number (17 out of 24) cured of constipation; 31 patients on insulin therapy required maintenance doses during treatment but all were subsequently cured; of 25 patients with various neurological lesions, 21 were freed of laxative treatment with four only remaining on sub-laxative doses.