Methyldopa-induced diarrhea: a case of iatrogenic diarrhea leading to request for nursing home placement

Article Abstract:

Nursing home placement was requested by the caregiver of an 84-year-old black female, diagnosed with Alzheimer's disease, because of severe diarrhea of more than ten stools per day. This patient had a history of stool incontinence and diarrhea for the previous seven years with up to six bowel movements per day. She had been responsive only to Lomotil (diphenoxylate), which reduced stools to three per day. Physicians responsible for her care did not know that when the patient's niece did not give her one of her medications the diarrhea was less frequent. Two months prior to the request for nursing home placement a home visit by a physician recorded that the patient was in generally good health, except for her diminished mental status and weakness from a previous stroke. Stool cultures at that time and repeated shortly thereafter were negative for pathogens. The caregiver was instructed to withhold the patients's Aldomet (alpha methyldopa, to reduce high blood pressure) and, two days later, the Lomotil. Within one week the patient had no further incontinence or diarrhea and her blood pressure was stable. Although the mechanism for Aldomet-induced diarrhea is not known and a leading text does not include it as a side-effect of the drug, other cases have been described in the literature. Additional issues provoked by this case study are common to geriatric health care. When multiple medical personnel are involved in the care of a patient, greater effort must be made to learn about current medications and to communicate therapies to others. Older patients require close monitoring of their medications because the metabolic changes of age and disease may necessitate changing dosages or discontinuing drugs.

Health aspects, Aged, Elderly, Complications and side effects, Aldomet (Medication), Lomotil (Medication)

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Pathophysiology of acute diarrhea

Article Abstract:

Normal bowel function is characterized by the production of bowel movements (stools) ranging from two or three times a day to two or three times a week. When food passes through the gastrointestinal (GI) tract, it is mixed with water, and most of this water is reabsorbed in the large intestine. Problems affecting this organ can lead to the production of diarrhea. Diarrhea is defined as the frequent passage of unformed, watery stools and is a major health problem in third world countries. It can lead to severe dehydration and death, especially in infants, when not treated. Causative factors of diarrhea include: an increase in the ability of the intestinal contents to draw water into the GI tract, a decrease in the amount of water that is re-absorbed from the intestinal contents, an increase in intestinal movement, and an increase in the amount of water secreted by the intestines. All of these factors increase the water content of stool. Diarrhea lasting only a few days is often due to bacterial infection, which increases intestinal water secretion. Bacteria cause diarrhea by attaching directly onto the cells that line the intestines and by secreting toxins into the GI tract. Anti-diarrheal medications work largely by removing the offending agent from the intestines or by inhibiting intestinal movement. The latter method slows the transit time for food through the intestine, and leads to an increase in water reabsorption. As other causes of diarrhea are uncovered and understood, additional effective agents may be developed to help treat this disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Enterobacteriaceae

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Introduction: management of acute nonspecific diarrhea

Article Abstract:

Normal bowel function is characterized by the production of bowel movements ranging from two to three times a day to two to three times a week. Diarrhea is an abnormal bowel condition characterized the frequent passage of unformed, watery stool. It is a major cause of infant death in third world countries, but in the United States, it is more of a nuisance. Diarrhea lasting less than three days is called acute and affects 44 percent of the US population each year. It is the second most common symptom of illness. Causative factors of acute diarrhea include: viral and bacterial infections, anxiety, and intestinal irritants, such as spicy foods and alcohol. Adults are affected the most, suffering about four episodes a year; children under 12 have two to three episodes a year, and teenagers have only two cases a year. Almost 70 percent of patients with acute diarrhea are seriously hindered in their daily activities; this can result in serious economic losses. The average adult loses about three days of work each year, and this equals a $608 million loss in US productivity. In Houston, when children enrolled in day care centers are ill with diarrhea, parents stay home an average of five days each year. This translates into a $33 million productivity loss for the city. A recent symposium entitled 'The Management of Acute Nonspecific diarrhea' was organized to inform physicians about the current trends regarding the cause, diagnosis and treatment of this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Demographic aspects

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