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July 25, 1966

Controlled Diarrhea in the Treatment of Cirrhosis

Author Affiliations

From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore. Dr. Gertman was a senior medical student; he is now serving an internship at Duke University Hospital, Durham, NC. Dr. Gagnon is now at St. Sacrement Hospital, Quebec.

JAMA. 1966;197(4):257-260. doi:10.1001/jama.1966.03110040067017

Fluid and electrolyte problems or ascites in patients with cirrhosis of the liver are usually managed by a combination of controlled dietary intake of fluid and sodium and enhancement of renal excretion. Occasionally, in severely ill patients oliguria develops or the kidneys are not responsive to diuretic agents. In an attempt to find an effective alternative to renal diuresis, the use of the intestinal tract to increase sodium or water loss from the body was examined. In 1933 Carr and Krantz1 observed that the oral feeding of mannitol to rats produced a marked diarrhea. Ellis and Krantz2 reported that the "threshold dose" for laxative effect in man was 10 to 20 gm of orally administered mannitol. According to information furnished by the Pharmacology Branch and on file with the Federal Drug Administration, the manufacturer has found that approximately 14 gm of mannitol will produce diarrhea in man. In