Loperamide Misuse Mimicking Symptoms of Severe Malnutrition

Area of Science:

• Pharmacology
• Adolescent Medicine
• Toxicology

Background:

• Loperamide, an over-the-counter medication for diarrhea, acts as a μ-opioid receptor agonist.
• While safe at recommended doses, high doses can lead to systemic effects and misuse.
• Increasing loperamide misuse is noted within the context of the US opioid epidemic.

Purpose of the Study:

• To report a case of a 16-year-old with anorexia nervosa presenting with non-specific symptoms attributed to malnutrition and postural orthostatic tachycardia syndrome (POTS).
• To highlight the diagnostic challenge posed by surreptitious high-dose loperamide use.
• To emphasize the importance of considering loperamide misuse in adolescents with unexplained symptoms.

Main Methods:

• Case report of a 16-year-old female with anorexia nervosa.
• Detailed clinical history, symptom progression, and management attempts.
• Diagnosis of chronic surreptitious high-dose loperamide use confirmed by symptom improvement after cessation.

Main Results:

• The patient experienced dizziness, syncope, constipation, and acute urinary retention.
• Symptoms initially misattributed to malnutrition and POTS.
• Rapid symptom resolution occurred after discontinuing loperamide.

Conclusions:

• Loperamide misuse can present with non-specific symptoms that overlap with other adolescent conditions.
• Adolescent medicine clinicians should be vigilant for signs of loperamide misuse.
• Awareness of loperamide's potential for misuse and its complications is essential for effective patient management.