Editorial: hyponatremia - a possible but forgotten consequence of bowel preparation for colonoscopy

Scarpignato, Carmelo; Blandizzi, Corrado

doi:10.1111/apt.12917

Cited by 6 publications

(5 citation statements)

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“…Hyponatraemia in cleansing studies has been previously reviewed. 18 In the present study, one patient in each group had hyponatraemia (Na<138 mEq) at the end of colonoscopy. In these three patients, the respective values of Na at baseline, at the end of dosing and at the end of colonoscopy were 136, 136 and 136 in the patient from the PEG-Asc-S group, 138, 139 and 135 in the patient from the PEG-Asc-M group, and 130, 130 and 131 in the patient from the PEG-ES group.…”

Section: Resultsmentioning

confidence: 56%

Randomised clinical study comparing the effectiveness and physiological effects of hypertonic and isotonic polyethylene glycol solutions for bowel cleansing

Yamano

Matsushita

Yoshikawa

et al. 2016

BMJ Open Gastroenterol

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ObjectivesBowel cleansing is necessary before colonoscopy, but is a burden to patients because of the long cleansing time and large dose volume. A low-volume (2 L) hypertonic polyethylene glycol-ascorbic acid solution (PEG-Asc) has been introduced, but its possible dehydration effects have not been quantitatively studied. We compared the efficacy and safety including the dehydration risk between hypertonic PEG-Asc and isotonic PEG regimens.DesignThis was an observer-blinded randomised study. Participants (n=310) were allocated to receive 1 of 3 regimens on the day of colonoscopy: PEG-Asc (1.5 L) and water (0.75 L) dosed with 1 split (PEG-Asc-S) or 4 splits (PEG-Asc-M), or PEG-electrolyte solution (PEG-ES; 2.25 L) dosed with no split. Dehydration was analysed by measuring haematocrit (Ht).ResultsThe cleansing time using the hypertonic PEG-Asc-S (3.33±0.48 hours) was significantly longer than that with isotonic PEG-ES (3.05±0.56 hours; p<0.001). PEG-Asc-M (3.00±0.53 hours) did not have this same disadvantage. Successful cleansing was achieved in more than 94% of participants using each of the 3 regimens. The percentage changes in Ht from baseline (before dosing) to the end of dosing with PEG-Asc-S (3.53±3.32%) and PEG-Asc-M (4.11±3.07%) were significantly greater than that with PEG-ES (1.31±3.01%).ConclusionsThese 3 lower volume regimens were efficacious and had no serious adverse effects. Even patients cleansed with isotonic PEG-ES showed significant physiological dehydration at the end of dosing. The four-split PEG-Asc-M regimen is recommended because of its shorter cleansing time without causing serious nausea.Trial registration numberUMIN000013103; Results.

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Section: Resultsmentioning

confidence: 56%

Randomised clinical study comparing the effectiveness and physiological effects of hypertonic and isotonic polyethylene glycol solutions for bowel cleansing

Yamano

Matsushita

Yoshikawa

et al. 2016

BMJ Open Gastroenterol

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“…Hyponatremia has been dubbed “a forgotten consequence of bowel preparation for colonoscopy” [ 34 ]. When too much fluid is ingested in too little time, concomitant low dietary solute intake is a fundamental factor predisposing patients to “bowel prep hyponatremia”, particulary in the context of ongoing AVP secretion.…”

Section: Discussionmentioning

confidence: 99%

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

2017

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BackgroundSymptomatic hyponatremia is considered a rare complication of oral bowel preparation for colonoscopy. The pathophysiology underlying this phenomenon has been widely regarded as a mere sequela of excessive arginine vasopressin (AVP) release.Case presentationThis case describes a 61-year old woman who developed acute hyponatremic encephalopathy when preparing for elective outpatient lower endoscopy. She had had negligible oral solute intake for two days and ingested four liters of clear fluid within two hours. On admission, the patient was agitated and had slurred speech. Treatment with hypertonic saline lead to full recovery. A brisk aquaresis confirmed acute dilutional hyponatremia.ConclusionApart from elevated AVP-levels, the amount and speed of fluid intake and concomitant low-solute intake constitute important risk factors in the development of clinically relevant hyponatremias in patients undergoing colonoscopies. Understanding that the cause of sodium imbalance in this scenario is multifactorial and complex is pivotal to recognizing and ideally preventing this complication, for which we propose the term “bowel prep hyponatremia”.

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“…13 Hyponatremia has been described as 'a possible but forgotten consequence of bowel preparation for colonoscopy. 16 Colonoscopists should be acquainted with this complication because it can result in electrolyte abnormalities which in turn can lead to serious neurological sequelae.…”

Section: Discussionmentioning

confidence: 99%

Frequency of hyponatremia caused by sodium picosulfate solution when used as a bowel cleansing agent for colonoscopy

et al. 2020

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Objective: To determine the frequency of hyponatremia in patients taking Sodium Picosulfate Solution (SPS) solution for bowel preparation prior to colonoscopy and to compare serum sodium levels before and after SPS. Methods: This interventional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between June 2019 to November 2019. Patients undergoing colonoscopy were included in the study. All patients were given SPS. Two samples of blood for electrolytes were taken, one 30 minutes before taking SPS solution and another 30 minutes before colonoscopy. Paired sample t-test was used to determine the difference between serum sodium level before taking the colonoscopy solution and serum sodium level before colonoscopy. Results: Fifty- four patients fulfilling inclusion criteria were included. Out of the 54 patients 28 (51.9%) were males and 26 (48.1%) were females. Mean sodium levels before taking colonoscopy solution was 139.7±3.5 mEq/L and mean sodium level before colonoscopy was 138.9±3.8 mEq/L. The difference between serum sodium level before taking SPS colonoscopy solution and before colonoscopy was found to be statistically insignificant (t (53) = 1.308; p = 0.196). Conclusion: No serious adverse effects were reported in any of our patients. There was no significant difference in the serum sodium level of patients undergoing colonoscopy before taking SPS bowel preparation solution and serum sodium level before colonoscopy. doi: https://doi.org/10.12669/pjms.36.7.2376 How to cite this:Rasheed T, Alvi H, Shaikh MA, Ali FS, Zuberi BF, Subhan W. Frequency of hyponatremia caused by sodium picosulfate solution when used as a bowel cleansing agent for colonoscopy. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2376 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Editorial: hyponatremia - a possible but forgotten consequence of bowel preparation for colonoscopy

Cited by 6 publications

References 11 publications

Randomised clinical study comparing the effectiveness and physiological effects of hypertonic and isotonic polyethylene glycol solutions for bowel cleansing

Randomised clinical study comparing the effectiveness and physiological effects of hypertonic and isotonic polyethylene glycol solutions for bowel cleansing

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

Frequency of hyponatremia caused by sodium picosulfate solution when used as a bowel cleansing agent for colonoscopy

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