Jejunal Ulceration and Stricture Due to Wax-Matrix Potassium Chloride Tablets and Amitriptyline

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Abstract
A 68‐year‐old woman presented with abdominal distention of several weeks duration and an acute small bowel obstruction. For several years she had been prescribed amitriptyline 150 mg/d, L‐thyroxine 100 μg/d, and digoxin 0.25 mg/d. For the previous year she had been taking hydrochlorothiazide 50 mg/d and wax‐matrix KCl 20 mEq/d for hypertension. At surgery a “napkin‐ring” stricture of the midjejunum was found. It had microscopic features consistent with KCl local toxicity. It is speculated that delayed gastrointestinal motility secondary to amitriptyline predisposed this patient to wax‐matrix KCl toxicity and that this potential side effect be considered when prescribing wax‐matrix KCl.