A life threatening complication after ingestion of sodium phosphate bowel preparation

Woo, Y. Mun; Crail, Susan; Curry, Graham; Geddes, Colin C.

doi:10.1136/bmj.333.7568.589

Cited by 14 publications

(7 citation statements)

References 13 publications

(20 reference statements)

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“…Although other bowel preparations have the potential to disturb electrolyte balance 118, 119 NaP appears to be particularly prone to causing imbalance. Whilst increasing age and impaired renal function may alert the clinician to the potential for problems, 120 significant electrolyte abnormalities may occur in apparently healthy individuals 115…”

Section: Discussionmentioning

confidence: 99%

Systematic review: oral bowel preparation for colonoscopy

Belsey¹,

Epstein

Héresbach

2006

Aliment Pharmacol Ther

225

179

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Section: Discussionmentioning

confidence: 99%

Systematic review: oral bowel preparation for colonoscopy

Belsey¹,

Epstein

Héresbach

2006

Aliment Pharmacol Ther

225

179

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“…Two meta analyses, comprising 71 trials (10 201 subjects) and 18 trials (2792 subjects) respectively, previously concluded that sodium phosphate-based bowel preparations resulted in a more complete and better quality of bowel preparation compared to 4-L PEG [44,45] , mainly due to the poorer compliance with the latter [46][47][48][49] . However, sodium phosphate is associated with significant fluid and electrolyte shifts due to its hyperosmotic nature and patients with renal impairment, dehydration, on angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers can develop renal failure [50][51][52] .…”

Section: Bowel Cleansing Agentsmentioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

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Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

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“…The incidence of acute kidney injury after use of sodium phosphate, which is also known as acute phosphate nephropathy, was reported in a range of 1% to 4%, which is similar to that of contrast nephropathy in general population [7]. Despite the mechanism of kidney injury from use of sodium phosphate solution is multifactorial including those predisposing factors described above, renal biopsy of these patients uniformly showed deposition of calcium-phosphate crystals as nephrocalcinosis leading to tubulointerstitial nephropathy [2] [6] [8]. The trigger of innate immune system with release of pro-inflammatory mediators in response to intraluminal calcium-phosphate crystal deposition and binding to tubular epithelial cells leading to chronic inflammation and fibrosis have also been hypothesized as possible mechanism of kidney injury after use of sodium phosphate [2] [8].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the mechanism of kidney injury from use of sodium phosphate solution is multifactorial including those predisposing factors described above, renal biopsy of these patients uniformly showed deposition of calcium-phosphate crystals as nephrocalcinosis leading to tubulointerstitial nephropathy [2] [6] [8]. The trigger of innate immune system with release of pro-inflammatory mediators in response to intraluminal calcium-phosphate crystal deposition and binding to tubular epithelial cells leading to chronic inflammation and fibrosis have also been hypothesized as possible mechanism of kidney injury after use of sodium phosphate [2] [8]. On the other hand, the complication from use of sodium phosphate may also potentiate acute renal failure in those with concomitant use of nephrotoxic medications such as non-steroidal anti-inflammatory drugs, and metformin which is associated with metformin-associated lactic acidosis [9].…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Potentially Fatal Complication in a Patient without Predisposing Factor Following Oral Bowel Preparation Commonly Used for Colonoscopy

Li¹,

Leung²,

Tsui³

2016

OJEM

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We described the case report of a patient presented with no known predisposing factor, generalized malaise with vomiting, locked jaw, perioral paraesthesia, carpopedal spasm and a positive Chvostek's sign which resulted from severe electrolyte disturbance at 5 hours after use of oral sodium phosphate solution (NaPO4) as bowel preparation for colonoscopy. On presentation, she developed hyperphosphatemia and symptomatic hypocalcaemia with serum phosphate of 1.84 mmol/L and adjusted calcium level 1.67 mmol/L respectively. Her symptoms subsided after immediate intravenous calcium gluconate followed by oral calcium supplement. The electrolyte disturbances were normalized with an uneventful clinical course. The potentially fatal complications of sodium phosphate solution which commonly prescribed as bowel preparation for conventional colonoscopy could develop though previously reported as uncommon in patients without predisposing factors, and should not be overlooked. Urgent assessment and immediate correction of electrolyte disturbances are needed. Recommendations on patient selection of use of sodium phosphate to minimize risk of developing adverse events are needed to incorporate in clinical protocols.

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A life threatening complication after ingestion of sodium phosphate bowel preparation

Cited by 14 publications

References 13 publications

Systematic review: oral bowel preparation for colonoscopy

Systematic review: oral bowel preparation for colonoscopy

Factors influencing quality of bowel preparation for colonoscopy

An Uncommon Potentially Fatal Complication in a Patient without Predisposing Factor Following Oral Bowel Preparation Commonly Used for Colonoscopy

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