The rapid development of hyponatraemia and seizures in an elderly patient following sodium picosulfate/magnesium citrate (Picolax)

Dillon, Cassandra Emily; Laher, M

doi:10.1093/ageing/afp054

Cited by 19 publications

(14 citation statements)

References 2 publications

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“…Whilst hyponatremia is the most frequent one, being reported in up to 7.5% -8.8% patients, it rarely achieves clinical significance. 4,9 Hyponatremia is defined as a serum sodium level less than 135 mEq/L. Symptoms do not normally occur unless the serum so dium level is lower than 120 mEq/L.…”

Section: Discussionmentioning

confidence: 99%

“…The age of these patients ranged from 64 to 80 years, one patient was taking thiazide diuretics and beta blockers, another patient had a previous history of gastrectomy, two patients used NaP solutions and two other patients used MC-SP complex. 5,6,9 Because of the osmotic activity of the chemical contents of the NaP and MC-SP complex, these solutions induce water and electrolyte abnormalities. 10 For this reason, elderly individuals and patients with impaired renal function, liver cirrhosis or congestive heart failure are more prone to these events.…”

Section: Discussionmentioning

confidence: 99%

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

Costa

Soares

2017

Acta Med Port

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RESUMOIntrodução: A preparação intestinal para colonoscopia e/ou cirurgia coloretal pode induzir alterações hidro-eletrolíticas. O risco destas alterações parece estar relacionado com o tipo de preparação intestinal, idade e comorbilidades dos doentes. Caso Clínico: Os autores apresentam dois casos de hiponatrémia sintomática (sinais neurológicos focais e coma) após preparação intestinal com picossulfato de sódio/citrato de magnésio para colonoscopia. Em ambos os casos, verificou-se resolução completa e rápida do quadro clínico depois da correção da hiponatrémia com solução intravenosa de NaCl a 3%. Discussão: Os distúrbios eletrolíticos são mais frequentes nas preparações à base de fosfato de sódio e picossulfato de sódio/ citrato de magnésio, nos doentes com mais de 65 anos ou medicados com diuréticos tiazídicos, inibidores da enzima de conversão da angiotensina, beta-bloqueantes e antidepressivos e em doentes gastrectomizados. Nestes doentes devemos preferir preparações intestinais à base de macrogol (polyethylene glycol). Conclusão: Em doentes de risco (idade superior a 65 anos, medicados com diuréticos tiazídicos, IECAs, beta-bloqueantes e antidepressivos, e antecedentes de gastrectomia) recomendamos soluções à base de macrogol. Palavras-chave: Catárticos/efeitos adversos; Colonoscopia; Hiponatrémia ABSTRACT Introduction: Bowel preparation for colonoscopy and/or colorectal surgery can cause electrolyte imbalances. The risk of electrolyte imbalances seems to be related to the type of bowel cleansing solution, age of patients and comorbidities. Case Report: We report two cases of symptomatic hyponatremia (focal neurological signs and coma) after bowel preparation with sodium picosulfate/magnesium citrate for colonoscopy. In both cases, symptoms related to hyponatremia rapidly disappeared after sodium level correction with intravenous administration of hypertonic saline (3% NaCl). Discussion: Electrolyte imbalances are more common with sodium phosphate-based solutions (NaP) and sodium picosulfate/ magnesium citrate, in patients older than 65, in patients treated with thiazide diuretics, angiotensin-converting-enzyme inhibitor, betablockers or antidepressants and in gastrectomized patients. These patients should use macrogol-based solutions (polyethylene glycol). Conclusion:In patients at risk (patient > 65 years old, patients taking thiazide diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers and antidepressants and with previous gastrectomy) we recommend macrogol-based solutions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Costa

Soares

2017

Acta Med Port

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“…A second report [3] from the Unites States of America again reports a female patient with pre-existing medical conditions, for which treatment could have contributed to hyponatraemia. A third report [4] from Ireland reports a female patient with no pre-existing medical conditions. The fourth report [5] from Korea describes a female patient with pre-existing medical conditions who was taking medications that can cause hyponatraemia.…”

Section: Discussionmentioning

confidence: 99%

Severe Hyponatraemia and Associated Seizure Following the Administration of Sodium Picosulfate/Magnesium Citrate (Picolax): A Case Report

Storrow¹

2015

J Clin Case Rep

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“…Sodium picosulfate/magnesium citrate (Picolax) has also been associated with hyponatremia and indeed in patients without risk factors for sodium concentration abnormalities [34,35] .…”

Section: Hyponatremiamentioning

confidence: 99%

Colonoscopy preparation-induced disorders in renal function and electrolytes

Florentin¹,

Liamis²,

Elisaf³

2014

WJGPT

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Colonoscopy and flexible sigmoidoscopy are commonly used mainly for colon cancer screening and detection, but also in several other situations such as inflammatory bowel disease (for diagnosis and follow up) and gastrointestinal hemorrhage. Bowel cleansing preparations mainly include polyethylene glycol and oral sodium phosphate solutions, with the later being most frequently used due to better toleration from patients. Despite their favourable safety profile these agents have been associated with renal function deterioration and electrolyte disorders, some of which were serious or even fatal. The present paper discusses the complications associated with colonoscopy preparation agents.

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The rapid development of hyponatraemia and seizures in an elderly patient following sodium picosulfate/magnesium citrate (Picolax)

Cited by 19 publications

References 2 publications

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

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

Severe Hyponatraemia and Associated Seizure Following the Administration of Sodium Picosulfate/Magnesium Citrate (Picolax): A Case Report

Colonoscopy preparation-induced disorders in renal function and electrolytes

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