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Laxative overdose

A laxative is a medication used to produce bowel movements. Laxative overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.

Most laxative overdoses in children are accidental. However, some people abuse laxatives by regularly taking overdoses in an effort to lose weight.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

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

Bisacodyl:

  • Cramps
  • Diarrhea

Senna; Cascara sagrada:

  • Abdominal pain
  • Bloody stools
  • Collapse
  • Diarrhea

Phenolphthalein:

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

Sodium phosphate:

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

Magnesium-containing products:

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

Castor oil can cause gastrointestinal irritation.

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

Products containing methylcellulose, carboxymethylcellulose, polycarbophil, or psyllium may cause choking or intestinal blockage if they are not taken with plenty of fluids.

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by Poison Control or a health care professional.

Before Calling Emergency

Determine the following information:

  • Patient's age, weight, and condition
  • The name of the product (ingredients and strengths if known)
  • Time it was swallowed
  • The amount swallowed
  • If the medication was prescribed for the patient

Poison Control

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 United States 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.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, heart function, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Activated charcoal
  • Blood and urine tests
  • Chest x-ray
  • EKG (electrocardiogram, or heart tracing)
  • Breathing support
  • Intravenous (through the vein) fluids
  • Laxative
  • Tube through the mouth into the stomach to empty the stomach (gastric lavage )

Outlook (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. Fluid and electrolyte (body chemical) imbalances may result, and fecal incontinence (inability to control bowel movements) may also develop. First time laxative overdoses are rarely serious.

Laxatives containing magnesium can cause serious electrolyte and heart rhythm disturbances in individuals with impaired kidney function.

Prevention

Keep all medications in child-proof bottles and out of the reach of children.

References

Malagelada JR, Malagelada C. Nausea and vomiting. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 8.

Sackeyfio AH, Gottlieb SJ. Anorexia nervosa and bulimia nervosa. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 291.

White SR, Hedge MW. Gastrointestinal toxicology. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 13.

Updated: 10/13/2013

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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