Overmatig laxeermiddelgebruik: Consequenties en klinisch chemische laboratoriumdiagnostiek

The use of laxative drugs is highly frequent and increasing every year. These drugs can be obtained with or without a physician's prescription, so called 'over the counter drugs'. Most patients use these drugs for the right purpose, namely complaints of constipation. However, a small minority of patients uses laxatives in an attempt to reduce intake of calories, increase loss of water and thereby achieve weight loss. Prolonged and excessive use of laxatives is associated with many disturbances in human physiologic systems, leading to a variety of clinical symptoms. Abuse of laxatives is not the first diagnose on the physician's list of possible explanations for the observed abnormalities. Moreover, patients often deny using laxatives when physicians suspect and ask about laxative substances. In order to raise awareness, especially for medical laboratory professionals, we here describe a case in which various and sometimes extreme abnormalities were found in the clinical laboratory. The combination of the patient's elaborate medical history and laboratory results pointed towards laxative abuse. This was finally confirmed by positive testing for large amounts of bisacodyl in urine.