Electrolyte abnormality, Neostigmine and Oglivie's syndrome

Q: Which electrolyte abnormality may prevent Neostigmine from resolving Ogilvie's syndrome?

Answer; Potassium

Acute colonic pseudo-obstruction or Ogilvie syndrome, is an acute large bowel obstruction with no evidence of mechanical colonic obstruction. It is said to be due to invasion and destruction of the splanchnic nerves, superior mesenteric ganglion, and celiac nerve plexus.

Neostigmine, an acetylcholinesterase inhibitor, increases acetylcholine concentrations at the enteric nervous system neuromuscular junctions, enabling smooth muscle to contract. Neostigmine is given as intravenous, 2 mg over 5 minutes. A repeat dosage may be given if necessary. Side effects of neostigmine include sweating, salivation, bradycardia, hypotension, and bronchospasm. Due to possible bradycardia, atropine should be available at the bedside. The neostigmine is eliminated by the kidney and should be used with caution in renal failure.

Reports indicate that patients with hypokalemia, may not respond to neostigmine. 

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#electrolytes

References:

1. Dolkar T, Adhikari S, Devi P, Nwani SO, Dogar M. Persistent Hypokalemia in a Patient With Ogilvie's Syndrome. Cureus. 2022 Nov 30;14(11):e32056. doi: 10.7759/cureus.32056. PMID: 36600873; PMCID: PMC9802540.

2. van Dinter TG Jr, Fuerst FC, Richardson CT, et al. Stimulated active potassium secretion in a patient with colonic pseudo-obstruction: a new mechanism of secretory diarrhea. Gastroenterology 2005; 129:1268.

3. Bazerbachi F, Haffar S, Szarka LA, et al. Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature. Neurogastroenterol Motil 2017; 29.