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Laxative-induced rhabdomyolysis.

Alfonso Merante¹, Pietro Gareri, Norma Maria Marigliano

¹Geriatrist, Geriatric Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

Clinical Interventions in Aging

|April 17, 2010

Summary

Elderly patients can develop severe rhabdomyolysis from excessive laxative use. High doses of lactulose and sorbitol caused electrolyte imbalances and muscle breakdown in a case study.

Keywords:

elderly laxatives over-the-counter drugs rhabdomyolysis

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Area of Science:

Geriatrics
Toxicology
Internal Medicine

Background:

Over-the-counter laxatives are commonly used, especially by the elderly.
High-dose or prolonged use of laxatives, including lactulose and sorbitol, can lead to adverse effects.
Electrolyte imbalances and rhabdomyolysis are potential, though often overlooked, complications.

Observation:

An 87-year-old woman presented with confusion, tremors, inability to walk, and fever.
She reported daily high-dose intake of lactulose and sorbitol syrup (approximately 70 g/day).
Physical examination revealed confusion, drowsiness, limb weakness, hyporeflexia, and mild fever.

Findings:

Laboratory tests showed severe hyponatremia, hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis.
Rhabdomyolysis markers were significantly elevated.
The patient experienced acute delirium during hospitalization.

Implications:

Laxative-induced rhabdomyolysis is a serious condition that can occur in the elderly.
Correction of electrolyte disturbances and supportive care are crucial for management.
Physicians must carefully monitor all medications, including over-the-counter drugs, in elderly patients due to potential fatal interactions and side effects.