Alternative Names: Laxative abuse

Poisonous Ingredient:

• Bisacodyl
• Carboxymethylcellulose
• Cascara sagrada
• Casanthranol
• Castor oil
• Dehydrocholic acid
• Docusate
• Glycerin
• Lactulose
• Magnesium citrate
• Magnesium hydroxide
• Magnesium oxide
• Magnesium sulfate
• Malt soup extract
• Methylcellulose
• Milk of magnesia
• Mineral oil
• Phenolphthalein
• Poloxamer 188
• Polycarbophil
• Potassium bitartrate and sodium bicarbonate
• Psyllium
• Psyllium hydrophilic mucilloid
• Senna
• Sennosides
• Sodium phosphate

Note: This list may not be all inclusive.

Where Found:

• Bisacodyl (Dulcolax)
• Cascara sagrada
• Castor oil
• Docusate (Colace)
• Docusate and phenolphthalein (Correctol)
• Glycerin suppositories
• Lactulose (Duphalac)
• Magnesium citrate
• Malt soup extract (Maltsupex)
• Methylcellulose
• Milk of magnesia
• Mineral oil
• Phenolphthalein (Ex Lax)
• Psyllium
• Senna

Note: This list may not be all-inclusive.

Symptoms:

Nausea, vomiting, abdominal cramping, diarrhea, are most common. Dehydration and electrolyte�problems are more common in children than adults. Below are symptoms specific to the actual product.

Bisacodyl:

• Electrolyte imbalance
• Cramps
• Diarrhea

Senna; Cascara sagrada:

• Abdominal pain
• Collapse
• Diarrhea
• Bloody stool

Phenolphthalein:

• Abdominal pain
• Collapse
• Low blood sugar
• Dizziness
• Rash
• Diarrhea
• Drop in blood pressure

Sodium phosphate:

• Abdominal pain
• Collapse
• Muscle weakness
• Vomiting
• Diarrhea

Magnesium-containing products:

• Collapse
• Painful urination
• Flushing
• Thirst
• Coma
• Muscle weakness
• Slow respirations
• Gastrointestinal�irritation
• Vomiting
• Abdominal pain
• Painful bowel movements
• Diarrhea (watery)
• Drop in blood pressure
• Death

Castor oil can cause gastrointestinal�irritation.

Mineral oil can cause aspiration pneumonia, a condition where vomited stomach contents are inhaled.

Methylcellulose, carboxymethylcellulose, polycarbophil, or psyllium may cause choking �or intestinal obstruction if taken with insufficient fluids.

Home Treatment:

DO NOT induce vomiting unless instructed to do so by Poison Control or by a physician.

Before Calling Emergency:

Determine the following information:

• Patient's age, weight, and condition
• The name of the product (ingredients and strengths if known)
• When it was swallowed
• The amount swallowed

Poison Control, or a local emergency number:

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the U.S. use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

If possible, take the container with you to the emergency room.

What to expect at the emergency room:

Some or all of the following procedures may be performed:

• Administering activated charcoal
• Monitoring vital signs ( blood pressure, pulse)
• Monitoring EKG (monitors heart function)
• Blood samples drawn to determine serum electrolyte levels
• Administering fluids and electrolytes through an IV

Expectations (prognosis):

How well a patient does�depends on�the type of laxative swallowed, how much was swallowed, and how much time passed before treatment was received.

Serious symptoms are most likely in patients who abuse laxatives by taking large amounts to lose weight. First time laxative overdoses are rarely serious.

References:

Ford MD,�Clinical Toxicology. 1st ed. Philadelphia, Pa: WB Saunders; 2001: 332-333.

Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtrans Gastrointestinal and Liver Disease. 7th ed. Philadelphia, Pa: WB Saunders; 2002:149.