Case of inappropriate ADH syndrome: Hyponatremia due to polyethylene glycol bowel preparation

Abstract

Colonoscopic screening has been reported to reduce deaths from colorectal cancer. Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods. Polyethylene glycol (PEG) is regarded as a safe method for cleansing, especially compared with oral sodium phosphate. Here, we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone (ADH) syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures. A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing. While waiting for the colonoscopy, she developed a stuporous mentality and generalized tonic-clonic seizures, which did not correlate with brain magnetic resonance imaging. Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome. Her thyroid and adrenal functions were normal. There were no malignancies, infections, respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications, which might have caused inappropriate ADH syndrome. She was treated with 3% hypertonic saline and showed a complete neurological recovery as her sodium levels recovered. Follow-up visits showed the patient to have a normal sodium level without neurologic deficits. This case shows that inappropriate ADH syndrome can be caused by PEG preparation, which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.

“Bowel prep hyponatremia“ – a state of acute water intoxication facilitated by low dietary solute intake: case report and literature review

“…In a case series involving 40 patients, raised AVP concentration after bowel cleansing but prior to endoscopy was found in 25% [ 20 ]. Therefore hyponatremia in this context has been traditionally regarded as a mere form of excessive AVP release [ 18 , 20 ].…”

Beer Potomania: A View on the Dynamic Process of Developing Hyponatremia

“…In our search, we have identified only two cases in which plasma vasopressin levels were reported. In one case, the level was not detectable [ 13 ], whereas a high level was measured in the other case [ 21 ]. These divergent values support the possibility of the dynamic nature of vasopressin secretion during the clinical course of hyponatremia.…”

Efficacy of ultra‐low volume (≤1 L) bowel preparation fluids: Systematic review and meta‐analysis

“…86 No serious AEs were reported in our included studies, but there are case reports that report on fatal hyponatremia and hypermagnesemia. 87 , 88 The rare risk of acute phosphate nephropathy caused by tubular calcium depositions due to NaP use has resulted in a warning by the United States Food and Drug Administration to consider alternative bowel preparations instead of NaP. 89 Therefore, hyperosmotic ≤1 L laxatives may be less suitable for elderly or patients with renal dysfunction.…”