Torsade de Pointes Associated With Laxative Abuse in a Patient Receiving Methadone

Laqueille, Xavier; Génin, Christophe; Pitrat, Benjamin; Lupuyau, Aline; Dervaux, Alain

doi:10.1176/appi.neuropsych.12090224

Cited by 3 publications

(7 citation statements)

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“…We reviewed the reported cases in which the laxatives had injurious consequences to the cardiac system by lowering the serum potassium level. The most common cardiotoxicity results from laxative‐induced hypokalaemia were ECG changes 1,3,16‐28,30,33,35,36,38 . These results are in line with the study of Marti et al, who concluded that in 4826 hypokalaemic patients (potassium < 3.5 mmol/L), about two‐thirds (69%) had ECG changes 42 …”

Section: Discussionsupporting

confidence: 87%

“…The pharmacological classes of laxative noted in our study were of 44% osmotic, 15,22,25,27‐29,31‐33,35,36,38 37% stimulant, 11,17,22,24,26,29,30,34,37,38 15% herbal 16,18,20,34 and 7% stool softeners, respectively 17,29 . 19% of cases did not specify the name of laxative taken 1,3,21,23,25 .…”

Section: Resultsmentioning

confidence: 63%

“…In 70% of the cases, the effect of the laxative on the heart was of typical hypokalaemic electrographic changes 1,3,16‐28,30,33,35,36,38 . In two cases, that is 7.4% of the total patients, there were abnormal changes in cardiac rhythm due to laxative‐associated hypokalaemia 29,37 .…”

Section: Resultsmentioning

confidence: 99%

“…In the end, 27 case reports were identified over the 24 years in 12 countries, as summarized in (Table 1). 1,3,11,15‐38 Most of the case reports were from the United States and the United Kingdom but spread across the whole world.…”

Section: Resultsmentioning

confidence: 99%

“…Severe hypokalaemia was most frequently caused by the herbal type of laxative, that is licorice 16,18,20 . In 17/27 (63%) cases, the reported events were the result of medication error and not due to a typical adverse drug reaction 1,3,11,17,19,21,22,24,26‐32,36,37 …”

Section: Resultsmentioning

confidence: 99%

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Adverse drug event of hypokalaemia‐induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports

Khan¹,

Khan

2020

J Clin Pharm Ther

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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.

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Section: Discussionsupporting

confidence: 87%