Atrial flutter is an uncommon supraventricular arrhythmia in young adults without structural heart disease and is typically associated with underlying cardiac pathology rather than isolated metabolic abnormalities. Electrolyte disturbances, particularly hypomagnesemia, can contribute to myocardial electrical instability, but they rarely present as the primary cause of atrial flutter in otherwise healthy young individuals. We present the case of a 23-year-old woman with a history of anorexia nervosa and generalized anxiety disorder who presented with acute palpitations, dizziness, and near-syncope. An electrocardiogram (ECG) was performed and demonstrated typical atrial flutter with a 4:1 atrioventricular conduction pattern in the setting of profound hypomagnesemia secondary to chronic stimulant laxative abuse. Laboratory studies also revealed mild hypokalemia and metabolic alkalosis consistent with ongoing gastrointestinal losses and severe nutritional restriction. She was treated with intravenous (IV) magnesium sulfate and potassium replacement without the use of antiarrhythmic medications, rate-control agents, or electrical cardioversion. Following correction of her electrolyte abnormalities, she spontaneously converted to normal sinus rhythm within several hours, with complete resolution of symptoms and no recurrence during her hospital stay. This case highlights how severe hypomagnesemia may have been a significant contributing factor to atrial flutter in a young patient without structural heart disease. It also emphasizes the importance of promptly identifying and correcting electrolyte abnormalities in patients with eating disorders and laxative abuse, as early treatment can rapidly reverse potentially serious but reversible cardiac manifestations and avoid unnecessary invasive management.

The accumulation of sand in the abdomen is a rising risk for colic in horses. Sand mainly accumulates in the ascending colon in the cranioventral abdomen. Evacuation of sand is facilitated by the application of psyllium supported with a laxative via nasogastric intubation. Laxatives currently used are either sodium sulfate/magnesium sulfate or mineral oil. The aim of this study was to compare the efficiency of polyethylene glycol, a laxative already used in human medicine for chronic constipation, with that of the above-described, established therapy options. Therefore, 44 horses diagnosed with sand enteropathy were randomly assigned and received psyllium in combination with either sodium sulfate, mineral oil or polyethylene glycol for four days. Pre- and post-therapy radiographs were assessed using a modified scoring system of Keppie et al. and Kendall et al. Adverse side effects during treatment were recorded and compared between treatment options. Median score reduction of sodium sulfate was -2 points, of polyethylene glycol -3.5 points and of mineral oil -2.5 points. Sand severity score was significantly reduced following all treatment options (p < 0.001), but did not differ between groups (p = 0.428). As all therapy regimens were successful in eliminating sand, polypropylene glycol might be the best option, as no adverse effects have been described in the literature or were seen in this study.

Sand enteropathy describes pathophysiological conditions of the equine gastrointestinal tract due to the uptake and accumulation of sand. It is an increasingly recognized cause of gastrointestinal disease in arid geographic areas. Clinical signs can vary widely from colic, fever and inappetence to poor performance. Diagnosis based solely on clinical signs is nearly impossible. The current literature describes a variety of diagnostic aids, with radiographic imaging considered the gold standard. Therapeutic approaches aim at the evacuation of sand from the abdomen. This can be achieved by the administration of psyllium in connection with a laxative via nasogastric intubation. Several studies describe varying laxatives such as mineral oil or sodium-/magnesium sulphate. This narrative review includes 39 publications up to the year 2026. We aim to raise awareness among practicing veterinarians and highlight new research objectives to improve knowledge and treatment of gastrointestinal diseases related to sand accumulation.

Physical stability is a critical aspect of tablet formulation, with excipients significantly influencing long-term tablet performance, especially under humid conditions. This study investigated storage-induced changes in increasingly complex tablet formulations by sequentially incorporating croscarmellose sodium (CCS), magnesium stearate (MgSt), and lactose into microcrystalline cellulose (MCC)-based tablets prepared at different porosities and stored at 50°C/75% RH for up to 42 days. Storage induced changes occurred through two distinct stages. The first stage was governed by moisture uptake, with most sorption occurring within the first day of storage, resulting in tablet swelling and tensile strength reductions of 16-51% depending on formulation and porosity. The rate of these structural changes was strongly correlated with sorption kinetics. The second stage occurred after moisture uptake had largely stabilised and was characterised by continued changes in liquid penetration and swelling behaviour (quantified by sessile drop analysis), and disintegration performance. These later changes were highly formulation dependent, with MgSt containing formulations showing the greatest deterioration, where disintegration times increased from approximately 40 s to 500 s after storage. DVS measurements successfully predicted moisture uptake and tensile strength evolution across formulations and porosity levels. The results demonstrate that tablet stability is governed by a sequence of moisture driven structural changes followed by slower performance related changes, providing a practical framework for predicting stability assessment and formulation development from short-term measurements.

A 74-year-old male with a history of problematic alcohol use, laxative and proton pump inhibitor consumption, presented with acute behavioral changes, tremors, gait disturbance, nystagmus, and tonic-clonic seizures associated with fever. A lumbar puncture was performed, showing no physicochemical abnormalities, no growth in cultures, and a negative polymerase chain reaction panel for common pathogens. Laboratory tests revealed severe hypomagnesemia, hypokalemia, hypocalcemia, and metabolic alkalosis. Neuropsychiatric symptoms and the acute symptomatic seizure were interpreted as secondary to electrolyte disturbances, mainly hypomagnesemia. Since Wernicke's encephalopathy could not be ruled out as a concurrent cause. Thiamine was administered along with aggressive electrolyte replacement, leading to reversal of the clinical picture. Neuropsychiatric manifestations in patients with hypomagnesemia are uncommon and often underdiagnosed or underestimated. Although an association between Wernicke's encephalopathy and hypomagnesemia has been described, there is no strong evidence regarding the interaction of both processes and their consequences. It is known that failure to correct magnesium perpetuates or makes Wernicke's encephalopathy refractory to thiamine administration.

Constipation is a common gastrointestinal disorder that markedly affects health and quality of life. In Japan, magnesium-based and contact laxatives have long been widely prescribed. Since the launch of lubiprostone in November 2012, several new agents with novel mechanisms have been introduced, and their use has increased. However, to our knowledge, no nationwide study has examined their use. This study aimed to analyze nationwide trends and regional differences in the prescription of medications for constipation. We used data from the Japanese National Health Insurance Claims and Specific Health Checkup Database Open Data from fiscal years (FYs) 2019 to 2023, covering the period when all currently available constipation medications were on the market in Japan, and prior to the inclusion of the drug selection flowchart in the Evidence-Based Clinical Guidelines for Chronic Constipation 2023. Prescription trends were evaluated using defined daily doses per 1,000 inhabitants per day (DID), and regional variations were assessed using standardized claim ratios (SCRs). The DID for contact laxatives decreased during the study period, whereas the DID for other constipation medications increased. Magnesium oxide showed the smallest regional variation, whereas polyethylene glycol and linaclotide showed the largest variations in FY 2019 and FY 2023, respectively. Throughout the 5-year period, the highest SCRs for contact laxatives were observed in Akita, Iwate, and Aomori prefectures. Our findings provide a comprehensive nationwide picture of evolving constipation treatment patterns and regional variations in Japan, establishing baseline data for evaluating the impact of guideline dissemination and evidence accumulation on clinical practice.

Clinically, the repair of critical bone defects remains a significant challenge, and conventional single-layer scaffolds demonstrate constrained performance owing to their inability to mimic the hierarchical structure and complex functions inherent to natural bone. This study introduced a continuously 3D-printed biomimetic periosteum-bone integrated scaffold, which was designed to mimic the physiological structure of bone. The scaffold consists of an upper quaternary chitosan/carboxymethyl cellulose (CMC) loaded with MCol and magnesium ion (CMC/QCS@MCol+Mg[2+], CQ@MM) and a lower polylactic acid/polydopamine scaffold (PLA/PDA, PP). In the whole PP-QC@MM bilayer implant, the lower PP scaffold provides excellent mechanical properties for the entire implant. While the upper CQ@MM bioinspired periosteum scaffold enables sustained release of MCol and Mg[2+] via CMC/QCS loading. Critically, phenolic groups on the PP surface form hydrogen bonds with amino groups in CQ@MM, enabling stable interfacial bonding to integrate bioinspired periosteal-bone scaffold. Additionally, the upper CQ@MM scaffold further accelerates bone repair by promoting neural repair, as well as enhancing vascularized bone regeneration and antibacterial property. The PP-QC@MM bioinspired periosteal-bone integrated scaffold significantly promoted bone regeneration in a rat cranial critical defect model, establishing a novel strategy and theoretical basis for the repair of critical-sized bone defects.

Developing adsorbents that offer both high adsorption performance and easy separation from water is essential for practical heavy metal removal. In this study, a hydrogen-bonded network was constructed using waste wood sawdust, magnesium hydroxide (Mg (OH)2) and sodium carboxymethyl cellulose (CMC). Waste wood sawdust was activated by alkali-thermal treatment to remove hemicellulose and rearrange the cellulose chains of wood, which increased its surface reactivity and facilitated the uniform immobilization of Mg(OH)2 nanosheets. CMC was introduced to establish a cross-linked composite membrane with strong hydrogen bonding interactions among the polymer chains and Mg(OH)2. This interconnected network greatly enhances the structural stability of the membrane, effectively preventing particle loss of nanocomposites and ensuring rapid separation from water. The membrane exhibits high adsorption capacities of 745.2, 1024.8 and 1162.3 mg·g-1 for Cu2+, Cd2+ and Pb2+, respectively, and maintains over 98% removal efficiency after ten cycles. Moreover, the composite membrane can be readily fabricated in various sizes and geometries to meet practical requirements. This study presents a facile and cost-effective route for shaping dispersed materials into structured forms with high and stable adsorption performance.

Although a potential association between laxative use and the development of acute kidney injury (AKI) has been proposed, it remains inadequately investigated. Therefore, the objective of this study was to elucidate the association between the use of each laxative and the risk of developing AKI. Data were obtained from the JMDC hospital-based administrative claims database, covering the period from April 2014 to August 2022. Laxatives were defined as lubiprostone and linaclotide (secretory drugs), senna (a stimulant), and magnesium oxide (a nonabsorbed substance). AKI was defined in accordance with the recommendations of the Kidney Disease: Improving Global Outcomes working group. After screening, 159,630 patients were eligible for inclusion. AKI occurred in 693 patients (94/1000 patient-years) in the magnesium oxide group, 67 (153/1000 patient-years) in the lubiprostone group, 194 (109/1000 patient-years) in the senna group, and 22 (161/1000 patient-years) in the linaclotide group. Cox regression analysis revealed that the use of lubiprostone (adjusted hazard ratio, 0.96; 95% CI, 0.74-1.24), senna (adjusted hazard ratio, 1.08; 95% CI, 0.91-1.27), and linaclotide (adjusted hazard ratio, 1.42; 95% CI, 0.92-2.17) did not decrease the risk of AKI compared with magnesium oxide. The findings suggest that there is no difference in AKI risk among the various laxatives studied. SIGNIFICANCE STATEMENT: The results indicate that there were no differences in the risk of acute kidney injury among lubiprostone, linaclotide, senna, and magnesium oxide, suggesting that the use of these laxatives might not impact the risk of acute kidney injury.

Chronic constipation (CC) is a common disorder of gut-brain interaction that markedly impairs quality of life and remains challenging to manage. Despite the availability of laxatives and prosecretory agents, up to half of patients experience suboptimal relief, underscoring the need for complementary, physiology-based nutritional strategies. Nutrients influence intestinal motility through multiple pathways, including enteroendocrine signalling, bile-acid metabolism, microbiota-derived metabolites, and intestinal taste-receptor activation. Integrating these mechanisms into clinical nutrition requires structured approaches that align fiber type, bile flow, microbial modulation, and sensory stimulation with motility phenotype and fermentation tolerance. Among dietary interventions, the most consistent clinical evidence supports the use of soluble fiber (e.g., psyllium), kiwifruit or prunes, and magnesium- or sulfate-rich mineral waters to improve stool frequency and consistency. Other components, such as fermented foods, probiotics, and generic hydration, show variable efficacy and remain supported primarily by physiological or translational data. The SMART (Sensory, Motor, bile Acid and Reflex Tailored) Constipation Diet (SCD) is proposed as a hypothesis-generating dietary framework that integrates fiber optimization, bile stimulation, microbial support, and chrono-nutritional timing into a coherent dietary model. Given the heterogeneity of CC (e.g., functional constipation, IBS-C, defecatory disorders) and the scarcity of phenotype-stratified trials, the SCD should be regarded as a translational concept rather than a validated clinical protocol. Future randomized, controlled studies with hard motility and symptom outcomes are needed to determine whether coordinated, multi-pathway dietary modulation can outperform single-component interventions and advance precision nutrition in CC.