What is known and objective
The imbalance in serum potassium caused by laxatives can negatively affect the cardiovascular system, leading to life‐threatening consequences. Our objective was to evaluate the reported evidence of adverse events related to the cardiac system due to laxative‐induced hypokalaemia from case reports.
Methods
A systematic electronic literature search of PubMed, Embase, the Cochrane Library and Science Direct was conducted for the period 1995‐2019. In these databases, search terms describing hypokalaemia and cardiotoxicity were combined with the term laxative use.
Results and discussion
Over the 23 years, 27 incidents were identified in 12 countries. There were 19 female and eight male patients, with ages ranging from 1 month to 93 years. The frequency of reported cases according to severity was the following: severe hypokalaemia 48%, moderate hypokalaemia 44.4% and mild hypokalaemia 7.4%. In 70% of patients, the effect of laxative on the heart was typical hypokalaemic electrographic changes, 7.4% showed abnormal changes in cardiac rhythm, whereas in 18.5%, the cardiotoxicity observed was a very serious kind. Two patients died due to severe cardiac effects.
What is new and conclusion
The laxatives—along with the involvement of some other contributing factors—caused mild‐to‐severe hypokalaemic cardiotoxicity. These factors were non‐adherence of the patient to the recommended dosage, laxative abuse, drug‐drug and drug‐disease interactions, non‐potassium electrolyte imbalances and the use of herbal laxatives. We recommend that laxatives and aggravating factors should be taken into account in the assessment of patients with suspected hypokalaemic cardiotoxicity.
The management of Borderline Personality Disorder (BPD) is limited to
psychological intervention along with pharmacotherapy. It is now evident
that chronodegeneration is one of clinical phenotype in BPD individuals,
therefore, the use of chronotherapeutics in BPD is developing day by
day. Therefore, we assess the chronotherapeutics either individually or
in combination with conventional therapeutic interventions to conclude
the best possible therapy for improvement of the BPD symptomatology. A
systematic electronic literature search of PubMed, Google Scholar,
Cochrane Central Register of Control Trials, Clinical Trials Registry
(ClinicalTrials.gov), APA PsycNET and BMJ evidence-Based Medicine was
conducted between 2000-2022. In these data bases, search terms
describing borderline personality disorder, and circadian rhythm
restoration were combined with the term of treatment. From five selected
studies, there are three types of chronotherapeutic interventions that
were practiced, as bright light therapy, physical exercise and triple
chronotherapy. Our included 4 out of 5 studies concluded chronotherapy
as a successful adjunctive therapy with pharmacotherapy and/or
psychotherapy in amelioration of BPD traits especially depression (Mean
Hamilton depression rating scale score decreases from 19.5 to 7.2) and
suicidal ideation (Mean Columbia suicide severity rating scale score
decreases from 19.5 to 7.2). One of our selected study on physical
exercise proved no significant effect on BPD when compared with control
group. According to our explored literature, chronotherapy particularly
bright light therapy might be a safe and effective addition to
conventional therapeutic interventions. It is principally effective for
patients in which depression is present as a co-morbidity or as a sign
of BPD.
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