Dulcolax
Brand Names: BisacodylPlease read the disclaimer concerning the intent
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References
Ewe K. Influence of diphenolic laxatives on water and electrolyte permeation in man. pp. 420-426. Monograph. 1977 Aug 12.
Ewe K, Holker B. [The effect of a diphenolic laxative (Bisacodyl) on water- and electrolyte transport in the human colon].
Klin Wochenschr. 1974 Sep 1;52(17):827-833. [Article in German]
Farack UM, Gruber E, Loeschke K. The influence of bisacodyl and deacetylbisacodyl on mucus secretion, mucus synthesis and electrolyte movements in the rat colon in vivo.
Eur J Pharmacol 1985 Nov 5;117(2):215-222.
Abstract: The effect of the diphenolic laxatives bisacodyl and deacetylbisacodyl on mucus secretion and fluid, sodium and potassium net transport was studied in rat colon perfused in vivo. Mucus output in the effluent was determined as total protein-bound hexose. Deacetylbisacodyl was more potent than the parent compound and was used to investigate dose-response relationships. At a low concentration (0.1 mg/dl), mucus and potassium secretion were stimulated whereas sodium and fluid absorption were inhibited, or converted to secretion, only at higher concentrations (0.5-3.0 mg/dl). All effects were dose-dependent and reversible within 1 h. With longer lasting perfusion of deacetylbisacodyl, mucus appeared in two peaks, one initial peak and another after 4 h. The late peak contained newly synthetized glycoproteins as indicated by the incorporation of intravenously injected [14C]galactose. It is concluded that stimulation of mucus secretion and synthesis contributes to the laxative action of bisacodyl. The effects of low versus high concentrations suggests that part of the potassium secretion is due to mucus release.
Fleming BJ, Genuth SM, Gould AB, Kamionkowski MD. Laxative-induced hypokalemia, sodium depletion and hyperreninemia. Effects of potassium and sodium replacement on the renin-angiotensin-aldosterone system. Ann Intern Med 1975 Jul;83(1):60-62.
Abstract: A patients with marked chronic hypokalemia (potassium, 1.7 to 2;3 meg/litre) and sodium depletion secondary to laxative abuse and dietary inadequacy was studied with respect to the renin-aldosterone system during sequential potassium and potassium-plus-sodium replacement. Extreme hyperreninemia of 20 Goldblatt units X 10-minus 4 was reduced to 0.9 with potassium replacement alone. Aldosteron excretion (15.8 mug/24 h) was initially low for a sodium-deprived state and high for a potassium-deprived state; it increased with potassium administration, but this rise was opposed by decreases in renin secretion induced by potassium and sodium administration. The results provide clinical confirmation of a dual effect of potassium on aldosterone secretion, with renin as a mediator.
Ritsema GH, Eilers G. Potassium supplements prevent serious hypokalaemia in colon cleansing.
Clin Radiol 1994 Dec;49(12):874-876.
Abstract: The association between colonic cleansing and hypokalaemia was studied prospectively by monitoring the serum potassium levels in four groups of patients: groups 1 (55 patients), 2 (72 patients), and 3 (97 patients) received the same 2-day preparation of 15 g magnesium sulphate and 10 mg bisacodyl twice daily; group 4 (96 patients) received a 1-day preparation of 2.4 mg sennoside per kg of bodyweight. Groups 1 and 2 were on diuretics, but only group 2 received potassium supplementation. Serum potassium levels were measured before and after bowel preparation. Hypokalaemia was present prior to cleansing in six (11%), and after cleansing in 20 (36%) of the 55 patients in the group 1 patients on diuretics but without potassium supplements. There was, after cleansing, no significant fall in serum potassium in the group 2 patients on diuretics who received potassium supplements. No hyperkalaemia resulted from supplementation. A significant fall of the mean level of serum potassium occurred in patients in both group 3 (2-day-preparation) and group 4 (1-day-preparation). We conclude that both 1 day and 2 days of cleansing with cathartics may result in a significant fall in serum potassium, which can be prevented by oral potassium supplements. Potassium supplements (three times a day 15 ml of potassium chloride with 0.9 mmol K per ml during the preparation) in patients on diuretics may be prudent to avoid the risk of cardiac arrhythmia.
Wright LF, DuVal JW Jr. Renal injury associated with laxative abuse. South Med J
1987 Oct;80(10):1304-1306.
Abstract: Surreptitious laxative abuse is a common cause of unexplained diarrhea, but has not been considered an important cause of irreversible electrolyte and renal functional abnormalities. We have described five patients with the laxative abuse syndrome associated with significant renal injury and electrolyte disorders. We conclude that laxative abuse, like analgesic abuse, is a cause of interstitial renal disease that is more common than generally recognized.