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NICE Clinical Knowledge Summary (CKS) on constipation in adults recommends a stepwise approach, typically starting with bulk-forming laxatives (such as ispaghula husk) for many adults, with osmotic laxatives (such as macrogol) added or substituted if response is inadequate or stools remain hard

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For stubborn dissolution: gentle inversion (not shaking) or placing the vial on a slow rotator at room temperature for 15 minutes can help

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Acute kidney injury can occur in cases of severe dehydration from persistent vomiting or diarrhea