Symptomatic Hyponatremia after Bowel Preparation: Report of Two Cases and Literature Review

Costa, Juliana M; Soares, João

doi:10.20344/amp.8794

Cited by 8 publications

(7 citation statements)

References 14 publications

(24 reference statements)

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“…Colonoscopy is a common procedure used for both diagnostic and therapeutic purposes in daily clinical settings and has a low risk of serious associated complications [1] . However, bowel preparations can cause electrolyte imbalance such as hyponatremia which can result in seizures, loss of consciousness, neurological symptoms and eventually coma [2] . The risk of electrolyte imbalance seems to be related to the type of bowel cleansing solution used, the age of the patient and their comorbidities [3] .…”

Section: Introductionmentioning

confidence: 99%

Hyponatremic Coma after Bowel Preparation

Costelha¹,

Dias

Teixeira

et al. 2019

European Journal of Case Reports in Internal Medicine

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IntroductionColonoscopy is a useful tool in modern medicine and is increasingly employed for both diagnostic and treatment purposes. However, bowel preparations can cause electrolyte imbalance, with the risk apparently related to the type of bowel cleansing solution used, the age of the patient and their comorbidities. Symptomatic hyponatremia, especially coma, is a rare complication of oral bowel preparation for colonoscopy and is thought to result from excessive antidiuretic hormone secretion.Case descriptionThe authors report the case of a 48-year-old man who developed symptomatic hyponatremia (coma) after bowel preparation with sodium picosulfate/magnesium oxide/citric acid prior to a colonoscopy. The patient was admitted to an intensive care unit where other causes of coma were excluded. The symptoms of hyponatremia rapidly resolved after sodium level correction with intravenous administration of hypertonic saline.DiscussionHyponatremic coma is an uncommon but serious complication of colonoscopy bowel preparation. Patients at risk (>65 years old, chronic kidney disease, heart failure, history of electrolyte problems, or taking thiazide diuretics, angiotensin-converting-enzyme inhibitors or antidepressants) should be closely monitored during bowel cleansing and macrogol-based solutions should preferably be used.LEARNING POINTSThe association between coma and hyponatremia should be kept in mind when patients undergo bowel preparation, especially if they have chronic kidney disease, heart failure, a history of electrolyte problems or are taking diuretics or antidepressants.Patients should be closely monitored (and their metabolic profile checked before bowel cleansing) and a low threshold maintained for investigation and treatment initiation in case of symptom development.Medications with the potential to cause fluid and electrolytes disturbances such as diuretics and antidepressants should be stopped or reduced in dose while the patient is undergoing bowel preparation.

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Section: Introductionmentioning

confidence: 99%

Hyponatremic Coma after Bowel Preparation

Costelha¹,

Dias

Teixeira

et al. 2019

European Journal of Case Reports in Internal Medicine

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“…The risk of electrolyte imbalances depends on the type of bowel preparation solution used, age of patient and other comorbidities. 11 …”

Section: Discussionmentioning

confidence: 99%

“… 12 There are case reports that SPS bowel preparation solutions can cause severe hyponatremia in some patients. 11 , 13 In a study by Cohen CD et al hyponatremia was assessed in 40 patients before and after colonoscopy in which 7.5% of patients developed hyponatremia after colonoscopy, with a concomitant increase in arginine vasopressin(AVP). 14 The release of AVP as a result of volume depletion secondary to bowel preparation has been described as a triggering factor for hyponatremia in this clinical setting.…”

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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“…4 Existem no mercado múltiplos agentes com diferentes formulações, sendo que os distúrbios eletrolíticos são mais frequentes naqueles à base de fosfato de sódio e picossulfato de sódio/citrato de magnésio, nos indivíduos com mais de 65 anos ou medicados com diuréticos tiazídicos, inibidores da enzima de conversão da angiotensina, beta-bloqueantes ou antidepressivos, 6 bem como em doentes com compromisso renal, hepático, insuficiência cardíaca 4 ou gastrectomizados. 7 Perante estas situações devem ser preferidas soluções intestinais isosmóticas à base de macrogol (polietilenoglicol), 9 uma vez que não alteram significativamente os parâmetros vitais ou o equilíbrio hidroeletrolítico. 4 Este caso clínico ilustra uma complicação consequente à preparação intestinal prévia à colonoscopia, realizada em contexto de investigação perante um quadro de retorragia, dor abdominal persistente nos quadrantes inferiores e PSOF positiva.…”

Section: Comentáriounclassified

“…Os fármacos mais frequentemente utilizados na preparação intestinal prévia à colonoscopia são o polietilenoglicol, o fosfato de sódio e o picossulfato de sódio/citrato de magnésio. 9 A anestesia ou a sedação podem associar-se a outro tipo de complicações, como reações alérgicas medicamentosas, hipotensão, flebite no local da punção e raramente falência cardiorrespiratória. 3 Em relação à colonoscopia per se, as complicações estão relacionadas com a técnica endoscópica e com os procedimentos terapêuticos, sendo a hemorragia e a perfuração intestinal as mais significativas.…”

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Colonoscopia: quando a preparação se torna uma complicação

Gaspar

Morais

2020

RPMGF

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A colonoscopia é o método de excelência para avaliação da mucosa do cólon e reto que, quando combinada com uma preparação intestinal adequada, permite diagnosticar patologia do cólon, reto e íleo terminal. Adicionalmente, apresenta uma vertente terapêutica que se traduz na excisão das lesões polipoides, 1 pelo que se tornou um exame amplamente prescrito. 2 A colonoscopia total representa a primeira linha de investigação perante a presença de sinais ou sintomas sugestivos de patologia do cólon ou reto, 1 nomeada

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Symptomatic Hyponatremia after Bowel Preparation: Report of Two Cases and Literature Review

Cited by 8 publications

References 14 publications

Hyponatremic Coma after Bowel Preparation

Hyponatremic Coma after Bowel Preparation

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

Colonoscopia: quando a preparação se torna uma complicação

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