In 2002, Belgium adopted a law decriminalizing euthanasia in certain situations. One of this law’s particularities is that it opens the physician’s possibility to practice euthanasia following a patient’s request, which can be based on a constant and unbearable psychic suffering, in the context of a serious accidental or pathological affection, even without a fatal outcome in the short-term. However, this law raises serious ethical issues in the field of mental health, both concerning the concept of diagnosis in psychiatry as well as the incurability of mental illness. This may result in dangerous interpretations. The psychiatric function itself appears to be rather destabilized and challenged by the application of this law. Excesses are possible, and an in-depth reflection is thus paramount concerning the need to better protect the rights of the most vulnerable, such as, among others, the mentally ill.

Introduction

Benzodiazepines withdrawal management is often accompanied by anxiety, resulting in a risk of relapse and the prescription of additional medications. A dry extract of Passiflora incarnata L. has previously demonstrated its usefulness in the first-line treatment of anxiety symptoms.

Subjects and methods

We performed a longitudinal study over a 3-month period wherein we initiated this medication in patients who were discontinuing long-term benzodiazepine use. Patients included in the study were all sufficiently stable and had been followed-up for at least three months in consultation. The benzodiazepine decrease scheduled was 25% of the initial dose every second week. Specific psychiatric interviewing was not used either before or during the study. We assessed the evolution of the anxiety score and the number of sexual intercourses in the course of drug withdrawal.

Results

Overall, 91 patients participated to this study, including 27 men (36.5%) and 47 women (63.5%). The mean age was 44.1 ± 11.0 years. The withdrawal success rate was 78.4% (95% CI: 69.0-87.8%). There was a clear and highly significant decrease in the Hamilton scale's anxiety scores, while the monthly frequency of intercourse was shown to slightly, though significantly, increase. Treatment with Passiflora incarnata L. was pursued in 70.3% of patients following total withdrawal of or reduction in benzodiazepine dosing.

Conclusions

A dry extract of Passiflora incarnata L. was shown to be safe, with significant favorable effects on anxiety scores. This product, therefore, may likely be used to improve benzodiazepine withdrawal symptoms.

Introduction. Hypokalemia is often discovered accidentally during routine check-ups. In some cases, however, it may be accompanied by severe symptoms like rhabdomyolysis, potentially leading to life-threatening cardiac rhythm disturbances.

Clinical case. We report the case of a 60-year-old woman admitted to the emergency department with marked anorexia, general weakness, diarrhea, and abdominal pain, which had progressively worsened over the last few weeks. Initial blood analyses showed hypokalemia (1.44mmol/L) as well as rhabdomyolysis (CK 6561 U/L). The cause of her condition could not be identified based on etiological investigations, whereas thorough history taking revealed massive chronic ingestion of cola (10 liters a day).

Discussion. The consumption of high quantities of cola can lead to hypokalemia through the effects of caffeine, glucose, and fructose. Caffeine induces severe hypokalemia by two mechanisms: intracellular redistribution of potassium and increased renal excretion of potassium. Additionally, substances with high fructose content cause osmotic diarrhea with secondary hypokalemia. The high glucose concentration in cola also induces hyperinsulinism, which is associated with intracellular redistribution of potassium.

Conclusion. Chronic and massive consumption of cola can lead to hypokalemia through intracellular potassium shifts, along with osmotic diarrhea caused by high fructose concentrations. Primary care physicians should inquire about soda consumption among their patients when confronted with unexplained cases of refractory hypokalemia.