[Factitious diarrhea in the differential diagnosis of chronic diarrhea. Observations on 7 patients]

Over the last seven years self-inflicted diarrhoea was diagnosed in seven patients with chronic diarrhoea which was deliberately induced by the secret intake of laxatives. Six of the patients were female, four of them in paramedical occupations. All also had loss of weight and hypokalaemia between 2.1 and 2.9 mmol/l. All had accepted extensive and interventional procedures during a mean of five hospital admissions, with minimal pathological findings and no aetiological diagnosis. They had undergone numerous therapeutic measures, in one instance even several operations and parenteral feedings. Making the correct diagnosis was decisively impeded and delayed by the patients' seeming cooperativeness. In four patients the diagnosis was finally made by demonstrating laxatives in the urine, in two others by finding hidden tablets in the room, in one by demonstrating melanosis of the colon. A factitious cause of chronic diarrhoea should be excluded if no other cause can be established.