@Anking-Maintainers
Support the change
But I would change the extra section to sth like this
- Acute laxative abuse ⟶ Metabolic acidosis (due to bicarbonate loss from diarrhea, leading to non-anion gap acidosis)
- Chronic laxative abuse ⟶ Metabolic alkalosis (due to volume depletion, RAAS activation, and renal K⁺/H⁺ loss)
Could someone check UW Step2 3593, Step1 18949, or Step 2 Comlex 100394?
step 2 ID “Although diarrhea (including factitious diarrhea) can lead to metabolic acidosis, metabolic alkalosis is a common and classic finding in laxative abuse. Several mechanisms likely contribute, including the profound hypokalemia as a result of increased loss of potassium in the stool.”
In the entire AMBOSS article about diarrhea, which includes laxative abuse and chronic vs acute diarrhea, only metabolic acidosis is mentioned
My only hesitation is that the text uses the wording “classically found.” I kinda would almost prefer only changing the text to say “chronic laxative abuse” and leave the cloze as is with clarification in the extra field.
I think whatever change is suggested, we need to clarify that there are two possible answers to this. I prefer keeping “metabolic acidosis” in the cloze.
@anking-maintainers
Given that there are 5 open suggestions on this, all suggesting the same change, I suggest we try to push it through soon. I try to add some changes to help balance everyones suggestions.
- Kept classically in the text and removed acidosis mainly because of this:
Classically usually means what NBME wants us to know or focus on, so I’m more inclined to keep this as the classic answer rather than the nuanced one.
We COULD mention chronic laxative abuse but then I think we’d need to create one for acute. OR we can do this
What acid base disturbance is classically found in patients with laxative abuse?
Acute: {{c1::Metabolic acidosis}}
Chronic: {{c1::Metabolic alkalosis}}
Personally don’t feel like we need the (September 2025) update in the extra field since we’re basically only changing the extra field currently.
@Ahmed7 good to push?