Severe edema after cessation of laxative abuse and use of a loop diuretic: Case report

Stimulant laxatives are the class of laxatives most often abused by patients with eating disorders. The abrupt cessation of high-dose stimulant laxatives is known to cause edema. We present the case of a patient with anorexia nervosa with binge-purge subtype who was taking ∼100 stimulant laxatives per day. Upon discontinuation of stimulant laxatives, she experienced severe peripheral edema with rapid gain of 11.6 kg over 1 week. Unique features of this case include the high quantity of stimulant laxatives consumed per day, the amount of weight gained due to edema, and the 3 month duration of edema after laxative cessation. This case report details the time course of development of edema after abrupt laxative cessation. It also details the dosing and duration of furosemide used for diuresis in order to provide a precedent to inform future care. This case calls into question the best treatment approach for patients with severe edema after laxative cessation who do not meet criteria for Pseudo Bartter syndrome.