Loperamide
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Reactions 1492, p30 - 15 Mar 2014 S Loperamide Bowel obstruction causing hydronephrosis following overuse in an elderly patient: case report An 81-year-old woman developed bowel obstruction causing hydronephrosis following overuse of loperamide for recurring diarrhoea. The woman had a history of diabetes mellitus, dementia, and chronic renal insufficiency; she had experienced recurring diarrhoea over the last year that had recently resolved after she had received increasing doses of loperamide from her family [dosage and route not stated]. She subsequently presented with a 1-week history of low-grade temperatures and fatigue [time to reaction onset not stated]. Examination showed a distended abdomen and she was referred to an emergency department where she became tachypnoeic. A Foley catheter was placed with an immediate output of 500mL of urine, but the woman’s symptoms and distention persisted. Laboratory studies showed a high blood urea nitrogen (133 mg/dL from her baseline of 106 mg/dL) and creatinine (2.5 mg/dL from her baseline of 2.2 mg/dL), a bicarbonate level of 12 mEq/L, an anion gap of 14 mEq/L, and a normal lactic acid level of < 0.3 mg/dL. An arterial blood gas showed the following: pH, 7.08; partial pressure of carbon dioxide, 28mm Hg; and partial pressure of oxygen, 81mm Hg. She was intubated and a CT of her abdomen and pelvis showed marked dilation of the sigmoid colon and rectum, with rectal faecal impaction; there was also moderate bilateral hydronephrosis, thought to be caused by mass effect from the dilated sigmoid. There was no obstructing calculus. She was transferred to an ICU and began an aggressive bowel regimen with manual disimpaction. Within 12 hours of disimpaction, her electrolytes and renal function had returned to baseline and she was extubated. A CT on hospital day 4 showed her sigmoid dilation and bilateral hydronephrosis had completely resolved. Author comment: "This case highlights a serious effect of overuse of a common antidiarrheal agent: loperamide." Zaniello B, et al. Over-the-counter medication overuse and bowel obstruction. Journal of the American Geriatrics Society 62: 400-402, No. 2, Feb 2014 - USA 803100492 1 Reactions 15 Mar 2014 No. 1492 0114-9954/14/1492-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Loperamide
Reactions 1492, p30 - 15 Mar 2014
SLoperamide
Bowel obstruction causing hydronephrosisfollowing overuse in an elderly patient: case report
An 81-year-old woman developed bowel obstructioncausing hydronephrosis following overuse of loperamide forrecurring diarrhoea.
The woman had a history of diabetes mellitus, dementia,and chronic renal insufficiency; she had experienced recurringdiarrhoea over the last year that had recently resolved after shehad received increasing doses of loperamide from her family[dosage and route not stated]. She subsequently presentedwith a 1-week history of low-grade temperatures and fatigue[time to reaction onset not stated]. Examination showed adistended abdomen and she was referred to an emergencydepartment where she became tachypnoeic.
A Foley catheter was placed with an immediate output of500mL of urine, but the woman’s symptoms and distentionpersisted. Laboratory studies showed a high blood ureanitrogen (133 mg/dL from her baseline of 106 mg/dL) andcreatinine (2.5 mg/dL from her baseline of 2.2 mg/dL), abicarbonate level of 12 mEq/L, an anion gap of 14 mEq/L, and anormal lactic acid level of < 0.3 mg/dL. An arterial blood gasshowed the following: pH, 7.08; partial pressure of carbondioxide, 28mm Hg; and partial pressure of oxygen, 81mm Hg.She was intubated and a CT of her abdomen and pelvisshowed marked dilation of the sigmoid colon and rectum, withrectal faecal impaction; there was also moderate bilateralhydronephrosis, thought to be caused by mass effect from thedilated sigmoid. There was no obstructing calculus. She wastransferred to an ICU and began an aggressive bowel regimenwith manual disimpaction. Within 12 hours of disimpaction,her electrolytes and renal function had returned to baselineand she was extubated. A CT on hospital day 4 showed hersigmoid dilation and bilateral hydronephrosis had completelyresolved.
Author comment: "This case highlights a serious effect ofoveruse of a common antidiarrheal agent: loperamide."Zaniello B, et al. Over-the-counter medication overuse and bowel obstruction.Journal of the American Geriatrics Society 62: 400-402, No. 2, Feb 2014 -USA 803100492
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Reactions 15 Mar 2014 No. 14920114-9954/14/1492-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
