Careful monitoring of medications is medically necessary
DEAR DR. ROACH: Your recent article on electrolytes reminded me of my mother’s experience. At 89, she was dizzy, fainting and falling. I took her to her doctor. Her blood tests showed dangerously low levels of electrolytes, and I was told to get her to the emergency room quickly. The doctor there determined that her problem was caused by drugs -- essentially, the blood pressure medicine prescribed by her doctor. She was hospitalized, put on appropriate IVs and recovered fully after four days. A doctor told me a person of advanced age who is on a diuretic has to be monitored as carefully as a baby. Needless to say, she hadn’t been.
It seems the body can’t regulate electrolytes properly in the face of poor doctoring. -- G. B.
ANSWER: I am sorry for your mother’s experience. I wish I could say it was unusual, but I have seen this before as well. Especially as we get older, our ability to maintain correct body functions, such as electrolyte levels, decreases. That leaves us susceptible to changes brought about by the environment or by medications.
In the case of hydrochlorothiazide ( HCTZ), a common diuretic, the result can be low sodium and low potassium levels. Careful monitoring is medically necessary.
I mentioned that my professor, Dr. Fred Coe, often remarked that a kidney is smarter than 10 interns. This was not just him being impressed by the kidney, but a reminder that physicians -- ju
nior and sometimes senior -- can make mistakes, and sometimes even the remarkable abilities of the kidney to maintain balance of salt and water can be overwhelmed.
DEAR DR. ROACH: I have read that activated charcoal supplements can be used effectively for upset stomach, intestinal disorders and other problems. It’s been used for decades in emergency rooms as an antidote for poisons and toxins. I’ve read that it does not distinguish toxins from non- toxins and can also bind with and assimilate medicines and health supplements, should they be present, and reduce their effectiveness. What is your opinion on using activated charcoal? -R. L.
ANSWER: Activated charcoal is a specially treated charcoal powder that is used medicinally to keep the body from absorbing many types of toxins.
My experience with activated charcoal is from the emergency department, mostly in people with drug overdose, both accidental and deliberate. Activated charcoal is unpleasant in taste and texture, and is often given with cathartics such as sorbitol, which can cause diarrhea in addition to the abdominal fullness and nausea the activated charcoal typically causes.
As such, it is appropriate only for ingestion of a toxin known to be treatable with it. A person with a mild upset stomach is likely to be unpleasantly surprised with their experience with activated charcoal, and I recommend against it. This is a powerful treatment not to be used lightly.
You are quite right that is can bind to and keep the body from absorbing many different kinds of medicines and nutrients. It has the potential for harm. Worse, activated charcoal is unable to stop absorption of some kinds of toxins, such as excess alcohol. It cannot “pull toxins” out of the body; it only reduces the absorption of something poisonous known to be ingested.
I have read it is supposed to be effective against hangover -- it isn’t. Not drinking irresponsibly is a more effective preventive for hangovers.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.