TITLE:
Acute symptomatic hyponatraemia following sodium picosulfate/magnesium citrate as bowel preparation for colonoscopy—A case series
AUTHORS:
Hannah Forde, Triona O’Shea, Colin Davenport, Diarmuid Smith
KEYWORDS:
Hyponatraemia; Colonoscopy; Sodium Picosulfate/Magnesium Citrate; Picolax
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.2,
February
12,
2014
ABSTRACT:
Oral purgatives such
as sodium phosphate and sodium picosulfate/magnesium citrate (Picolax) combinations are commonly used
as a preparation step for colonoscopies in Ireland. These substances can
occasionally cause significant electrolyte disturbances including hyponatraemia.
Although this is a rare complication of undergoing a colonoscopy, if not
treated promptly and appropriately, these electrolyte abnormalities can be
associated with life threatening complications. We report cases of symptomatic hyponatraemia
in three women aged 65-75 years, following ingestion of Picolax in preparation for a colonoscopy. All three patients had
documented previously normal electrolytes and all three required hospital
admission for management of their electrolyte disturbance. However, the
clinical presentations were variable and depended upon the severity of the
hyponatraemia. Patient 1 presented with nausea and vomiting 7 hours post Picolax ingestion. Plasma sodium was 124
mmol/l. She was diagnosed with mild symptomatic hyponatraemia, and treated with
anti-emetics and slow intravenous infusion of 0.9% Saline. Patient 2 developed
acute confusion 8 hours following ingestion of Picolax. Plasma sodium was 120 mmol/l and she was clinically
dehydrated. She was also treated with intravenous 0.9% Saline. Patient 3 presented
with seizures and reduced GCS, 48 hours post Picolax ingestion. Plasma sodium was 111 mmol/l. As she had severe
life threatening hyponatraemia with seizures, she was treated with boluses of
3% hypertonic saline. It is recommended that cleansing agents should be used
with caution in the elderly, patients with a low seizure threshold, patients
with renal impairment, liver cirrhosis, heart failure, and patients on
diuretics. These patients should have plasma sodium monitored pre- and post-colonoscopy
to ensure early detection of hyponatraemia if present, and to initiate prompt
and appropriate management to prevent the serious complications associated with
hyponatraemia.