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Disclaimer
This pocket guide attempts to define principles of practice that should produce high-quality patient
care. It is applicable to specialists, primary care, and providers at all levels. This pocket guide should not
be considered exclusive of other methods of care reasonably directed at obtaining the same results. The
ultimate judgment concerning the propriety of any course of conduct must be made by the clinician after
consideration of each individual patient situation.
Abbreviations
ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; ASCVD, atherosclerotic
cardiovascular disease; bid, twice a day; BP, blood pressure; CAC, coronary artery calcium; CGM,
continuous glucose monitor; CMP, complete metabolic panel; CVD, cardiovascular disease; FBC, full
blood count; GLP-1, glucagon-like peptide-1; GTT, glucose tolerance test; HbA1c, hemoglobin A1c;
HDL, high density lipoprotein; hsCRP, high-sensitivity C-reactive protein; LADA, latent autoimmune
diabetes in adults; LDL, low density lipoprotein; OTC, over-the-counter; SBP, systolic blood pressure;
SGLT-2, sodium-glucose co-transporter-2; TC, total cholesterol; TG/HDL, triglyceride to HDL
Table 6. Summary of Common Osmotic Laxatives
Type
Generic
Name Dosage
Side
Effects/
Problems
a
Mechanism
of Action
OTC Products
Hyperosmolar
agents
Sorbitol 15–30 mL
daily or bid
Sweet taste,
transient
abdominal
cramps,
flatulence,
bloating
Nonabsorbable
disaccharides
metabolized by
colonic bacteria
into acetic and
short-chain fatty
acids, which
accelerate colonic
transit
Lactulose 15–30 mL
daily or bid
Polyethylene
glycol
17 g/d Incontinence
due to potency,
bloating,
abdominal
cramps
Osmotically ↑
intraluminal fluids
Saline
laxative
Magnesium 15–30 mL
daily or bid
Magnesium
toxicity,
dehydration,
abdominal
cramps,
incontinence
Fluid osmotically
drawn into small-
bowel lumen,
cholecystokinin
stimulated, colon
transit time↓
Magnesium
citrate
5–10 fl oz
(150–300
mL) once
Avoid in renal
failure
a
Potentially all laxatives and constipation treatments may cause fecal incontinence.
