Severe Constipation with Medication-Related Etiology

Case at a Glance

A 37-year-old female presents with severe constipation lasting 6 days, unresponsive to magnesium citrate, with associated nausea and abdominal distension. Patient is currently taking Auvelity and Adderall, both medications known to potentially cause constipation as side effects.

Patient's Story

The patient reported a 6-day history of complete constipation with no bowel movements. She described her abdomen as hard to touch and experiencing significant discomfort. After taking magnesium citrate the previous day, she only passed small amounts of watery discharge with mucous-like material, but no substantial bowel movement. The patient also reported severe nausea, stating that after consuming a banana and applesauce, she felt the food was 'sitting below her throat' and experienced difficulty keeping food down. She expressed feeling extremely full and uncomfortable.

Initial Assessment

Physical examination would likely reveal abdominal distension with a firm, hard abdomen on palpation. The patient appears to be experiencing severe constipation with possible fecal impaction. Current medications include Auvelity (dextromethorphan/bupropion combination) and Adderall (amphetamine salts), both of which can contribute to constipation through their effects on gastrointestinal motility.

The Diagnostic Journey

The patient's symptoms suggest severe constipation potentially progressing to bowel obstruction, given the failure to respond to magnesium citrate and the presence of nausea with food intolerance. The medication history is significant, as both Auvelity and Adderall are known to slow gastrointestinal transit time. Assessment would include evaluation for fecal impaction and possible mechanical obstruction.

Final Diagnosis

Severe medication-induced constipation with possible fecal impaction, secondary to Auvelity and Adderall therapy.

Treatment Plan

Immediate interventions considered include: 1) Fleet enema or phosphate enema for immediate relief, 2) Polyethylene glycol (PEG) solution as recommended by healthcare providers, 3) Evaluation for emergency care given the severity and duration of symptoms, 4) Possible medication adjustment or bowel regimen initiation, 5) Gastroenterology consultation for ongoing management and prevention strategies.

Outcome and Follow-up

Patient advised to seek immediate medical attention given the severity of symptoms and failure to respond to initial treatment. Long-term management would include establishing a preventive bowel regimen while continuing necessary psychiatric medications, with regular monitoring and possible medication adjustments in consultation with prescribing physicians.