Quantitation of a Bisacodyl Metabolite in Urine for the Diagnosis of Laxative Abuse

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Abstract
Summary: A 2 year history of severe diarrhea, tiredness, and weight loss in a female patient could not be diagnosed satisfactorily despite repeated and extensive clinical investigations of various kinds. The final diagnosis of laxative abuse was arrived at after identification and quantitation of a bisacodyl metabolite in the urine from the patient. The metabolite was bisacodyl diphenol. The analytical method developed was based on liquid chromatographic determination after hydrolysis of the conjugated metabolite of bisacodyl and selective isolation from the urine. The precision of the method was 5% at the 2.3 μg/ml level (n = 9) of bisacodyl diphenol, and the absolute recovery was estimated at 80%. The method allowed detection of 0.5 μg/ml of the metabolite in urine. After a single dose (10 mg) of bisacodyl to volunteers, urinary concentrations of the metabolite in the range of 1-5 μg/ml were found. The bisacodyl diphenol recovered in the urine corresponded to 20-30% of the original dose. The urinary concentration of the diphenol derivative in the patient was estimated at 17 μg/ml.

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