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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; 36:1651-1654. [PMID: 33235591 PMCID: PMC7674881 DOI: 10.12669/pjms.36.7.2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Tazeen Rasheed
- Dr. Tazeen Rasheed, Assistant Professor, Dow University of Health Sciences, Karachi, Pakistan
| | - Haris Alvi
- Prof. Haris Alvi, MBBS, FCPS. Dow University of Health Sciences, Karachi, Pakistan
| | - Majid Ahmed Shaikh
- Dr. Majid Ahmed Shaikh, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Dr. Faiza Sadaqat Ali, Senior Registrar, Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Prof. Bader Faiyaz Zuberi, Dow University of Health Sciences, Karachi, Pakistan
| | - Wara Subhan
- Dr. Wara Subhan, Postgraduate trainee, Dow University of Health Sciences, Karachi, Pakistan
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Labuschagne GS, Morris RW. The effect of oral intake during the immediate pre-colonoscopy time period on volume depletion in patients who receive sodium picosulfate. Anaesth Intensive Care 2017; 45:485-489. [PMID: 28673219 DOI: 10.1177/0310057x1704500412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sodium picosulfate, used in combination with magnesium oxide and citric acid for bowel cleansing, can result in dehydration. We investigated whether enhanced carbohydrate fluid intake pre-colonoscopy could mitigate this effect. We enrolled 398 elective colonoscopy patients in a prospective, controlled, single-blinded study. The control group (n=194) fasted routinely (minimum seven hours) whilst the treatment group (n=197) drank 1,200 ml carbohydrate solution leading up to admission (up until two hours pre-colonoscopy). On admission a patient survey was completed, and urine specific gravity obtained. Supine blood pressure and pulse rate were measured, and repeated within three minutes of standing. The carbohydrate group had reduced symptoms and signs of dehydration, including thirst (34% versus 65%, P <0.001), dry mouth (45% versus 59%, P=0.008), dizziness (10% versus 20%, P=0.010), lower mean urine specific gravity (1.007 versus 1.017, P <0.001), lower incidence of orthostatic hypotension (2.6% versus 11%, P <0.001), and lower mean erect pulse rate (78 versus 81 /minute, P=0.047). The postural change in systolic blood pressure was less in the treatment group (mean -0.4 mmHg, median -1 mmHg [interquartile range, IQR -7 to 7]) than in the control group (mean -4.1 mmHg, median -1 mmHg [IQR -12 to 3], P=0.028). These findings indicate that hydration with carbohydrate solution in patients taking sodium picosulfate has clinical benefit.
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Affiliation(s)
- G S Labuschagne
- Visiting Medical Officer, Department of Anaesthesia, St George Hospital, Sydney, New South Wales
| | - R W Morris
- Head of Department, Department of Anaesthesia, St George Hospital and Clinical Associate Professor, University of New South Wales, Sydney, New South Wales
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Seong JH, Yoo JS, Lee KJ, Park HJ, Kim HM, Kim JW, Kim HS. Formulation and Management of Poor Bowel Preparation: A Survey Study. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 68:70-6. [DOI: 10.4166/kjg.2016.68.2.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jae Ho Seong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Sae Yoo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyong Joo Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hong Jun Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Man Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Woo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Klare P, Poloschek A, Walter B, Rondak IC, Attal S, Weber A, von Delius S, Bajbouj M, Schmid RM, Huber W. Single-day sodium picosulfate and magnesium citrate versus split-dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist-blinded trial. J Gastroenterol Hepatol 2015; 30:1627-34. [PMID: 25968966 DOI: 10.1111/jgh.13010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM The intake of polyethylene glycol (PEG) prior colonoscopy is frequently associated with nausea and abdominal discomfort. The aim of this study was to investigate whether sodium picosulfate and magnesium citrate (PMC) is superior to a polyethylene glycol (PEG) preparation in regard to patient acceptance. Furthermore, it investigates possible differences in efficiency and patient safety. METHODS In a randomised, prospective, and endoscopist-blinded study patients were 1:1 randomized to either use PMC or 4-L PEG in order to prepare for colonoscopy. Cleansing regimes consisted of a split-dose administration in the PEG arm and standard administration in the PMC arm. Primary end point was proportion of patients evaluating the bowel preparation procedure as "very distressing," defined as ≥ 8 points on a 10-point numeric rating scale (NRS). Secondary end points were quality of bowel preparation and electrolyte parameters. RESULTS PMC bowel-cleansing procedure was better tolerated compared with PEG (PMC(NRS<8) = 89.9% vs PEG(NRS<8) = 79.2%, P = 0.037). Mean declines in serum sodium (ΔSodium(PEG) = -0.76 ± 3.07 vs ΔSodium(PMC) = -3.38 ± 3.56 mmol/L; P < 0.001), chloride (ΔChloride(PEG) = -1.00 ± 3.22 vs ΔChloride(PMC) = -3.49 ± 3.51 mmol/L; P < 0.001), and osmolality (ΔOsmolality(PEG) = -4.23 ± 6.82 vs ΔOsmolality(PMC) = -8.83 ± 7.43 mosmol/kg; P < 0.001) were higher in the PMC arm than in the PEG arm. Hyponatremia after bowel preparation occurred more often in PMC (21.2%) than in PEG (4.0%) (P < 0.001). Successful preparation was achieved more frequently in the PEG arm (42.9% vs 82.2%; P < 0.001). CONCLUSION Standard picosulfate/magnesium citrate is better accepted than a split-dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is superior to PMC.
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Affiliation(s)
- Peter Klare
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Anne Poloschek
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Benjamin Walter
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ina-Christine Rondak
- Department of Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Soher Attal
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Weber
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stefan von Delius
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Monther Bajbouj
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Wolfgang Huber
- 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Bertiger G, Jones E, Dahdal DN, Marshall DC, Joseph RE. Serum magnesium concentrations in patients receiving sodium picosulfate and magnesium citrate bowel preparation: an assessment of renal function and electrocardiographic conduction. Clin Exp Gastroenterol 2015; 8:215-24. [PMID: 26251626 PMCID: PMC4524271 DOI: 10.2147/ceg.s79216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We performed a post hoc analysis of two clinical trials to assess whether sodium picosulfate and magnesium (Mg(2+)) citrate (Prepopik(®) [P/MC]), a dual-action bowel preparation for colonoscopy, has an impact on serum Mg(2+) levels and cardiac electrophysiology. Although rare, hypermagnesemia has been reported in patients consuming Mg(2+)-containing cathartics, especially patients who are elderly and have renal impairment. METHODS Data were analyzed from two prospective, Phase III, randomized, assessor-blinded, active-control, multicenter, pivotal studies that investigated split-dose/day-before P/MC. Serum Mg(2+) and creatinine clearance (CrCl) were measured at screening, on the day of colonoscopy, and 24-48 hours, 7 days, and 4 weeks after colonoscopy; electrocardiograms also were obtained at these time points. RESULTS In total, 304 patients received split-dose P/MC and 294 patients received day-before P/MC. Only 10% of the patients had serum Mg(2+) above the upper limit of normal (1.05 mmol/L) on the day of colonoscopy. There was a slight inverse correlation between CrCl and Mg(2+) levels on the day of colonoscopy; however, even at the lowest CrCl, serum Mg(2+) remained below clinically significant levels of 2.0 mmol/L. Increases in serum Mg(2+) were transient, with levels returning to baseline within 24-48 hours, regardless of renal function. No patients with elevated Mg(2+) experienced a corrected QT (QTc) interval >500 milliseconds or a QTc interval increase of ≥60 milliseconds from baseline. P/MC had no impact on PR or QRS interval. CONCLUSION P/MC produces little impact on serum Mg(2+) levels with no clinically significant effect on cardiac conduction in patients, including those with mild-to-moderate renal impairment.
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Affiliation(s)
| | - Edward Jones
- Delaware Valley Nephrology and Hypertension Associates, Philadelphia, PA, USA
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Gweon TG, Kim SW, Noh YS, Hwang S, Kim NY, Lee Y, Lee SW, Lee SW, Lee JY, Lim CH, Hun Kim H, Kim JS, Kyung Cho Y, Myung Park J, Seok Lee I, Myung-Gyu Choi. Prospective, randomized comparison of same-day dose of 2 different bowel cleanser for afternoon colonoscopy: picosulfate, magnesium oxide, and citric acid versus polyethylene glycol. Medicine (Baltimore) 2015; 94:e628. [PMID: 25837751 PMCID: PMC4554028 DOI: 10.1097/md.0000000000000628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
For afternoon colonoscopy, same-day administration of sodium picosulfate, magnesium oxide, and citric acid (PM/Ca) is recommended. However, few studies have evaluated the bowel-cleansing efficacy and safety of this regimen. The aim of this study was to compare the bowel-cleansing efficacy, side effects, and patient's tolerability of a same-day split administration of PM/Ca with polyethylene glycol (PEG) for afternoon colonoscopy. Patients were randomly assigned to a PM/Ca group or a PEG group. The PM/Ca group consumed 1 sachet of PM/Ca at 06:00 and 1 sachet of PM/Ca 4 hours before the colonoscopy. They also took 2 tablets of bisacodyl before sleep on the night before. The PEG group consumed 2 L of PEG at 06:00 and 2 L of PEG 4 hours before the colonoscopy. All subjects were instructed to finish the bowel cleanser or fluid at least 2 hours before colonoscopy. All colonoscopic examinations were performed in the afternoon on the same day. The bowel-cleansing efficacy was scored using 2 scales: the Ottawa Bowel Preparation Scale (OBPS) and the Aronchick scale. Ease of using the bowel cleanser was rated from 1 (very easy) to 5 (very difficult). Two hundred nine patients underwent colonoscopy. The bowel-cleansing scores by OBPS did not differ between groups (5.0 vs 4.9, P = 0.63). Ease of using the bowel cleanser was superior in the PM/Ca group (P < 0.01). The cleansing efficacy of PM/Ca administered on the day of colonoscopy is comparable to that of PEG. Patients prefer PM/Ca.
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Affiliation(s)
- Tae-Geun Gweon
- From the Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine
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Leitao K, Grimstad T, Bretthauer M, Holme Ø, Paulsen V, Karlsen L, Isaksen K, Cvancarova M, Aabakken L. Polyethylene glycol vs sodium picosulfate/magnesium citrate for colonoscopy preparation. Endosc Int Open 2014; 2:E230-4. [PMID: 26135098 PMCID: PMC4423298 DOI: 10.1055/s-0034-1377520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/06/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Polyethylene glycol-based electrolyte solutions (PEG-ELS) and the combination of sodium picosulfate/magnesium citrate (SPMC) are commonly used bowel preparation agents. The aim of the present study was to compare the two agents with regard to cleansing efficacy and tolerance among individuals scheduled for outpatient colonoscopy. MATERIALS AND METHODS The 368 colonoscopy outpatients at three Norwegian hospitals were randomized to bowel lavage with either PEG-ELS or SPMC. Compliance and patient tolerance were evaluated using a patient questionnaire. Bowel cleansing was evaluated using the Ottawa Bowel Preparation Quality Scale (OBPS), a validated scoring system with scores between 0 (best) and 14. RESULTS There was no difference in the cleansing quality between the PEG-ELS and SPMC groups (median OBPS 5.0 in both groups). The group that received SPMC reported better overall patient tolerance than the PEG-ELS group (72.6 % vs 59.0 % reporting no or slight discomfort, P < 0.01). Compliance with the recommended total fluid intake (4 L) was better in the SPMC group than in the PEG-ELS group (94.2 % vs 81.2 % respectively, P < 0.01); moreover, the polyp detection rate was superior (34.3 % vs 23.3 %, P = 0.02). CONCLUSION PEG-ELS and SPMC are equally effective in cleansing efficacy, but SPMC was better tolerated by patients and resulted in superior patient compliance and polyp detection rate. CLINICAL TRIAL REGISTRATION NCT01624454.
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Affiliation(s)
- Kristian Leitao
- Division of Gastroenterology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway,Corresponding author Dr. Kristian Leitao Stavanger University HospitalStavangerNorway+47-51-51-80-53Norway
| | - Tore Grimstad
- Division of Gastroenterology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Michael Bretthauer
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sorlandet Hospital, Kristiansand, Norway,Insitute for Health and Society, University of Oslo, Norway
| | - Vemund Paulsen
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Karlsen
- Division of Gastroenterology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Isaksen
- Division of Gastroenterology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | - Lars Aabakken
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Song KH, Suh WS, Jeong JS, Kim DS, Kim SW, Kwak DM, Hwang JS, Kim HJ, Park MW, Shim MC, Koo JI, Kim JH, Shon DH. Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation. Ann Coloproctol 2014; 30:222-7. [PMID: 25360429 PMCID: PMC4213938 DOI: 10.3393/ac.2014.30.5.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 05/21/2014] [Indexed: 12/31/2022] Open
Abstract
Purpose Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction. Methods In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale. Results The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B. Conclusion Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.
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Affiliation(s)
- Ki Hwan Song
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | - Wu Seok Suh
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | | | - Dong Sik Kim
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | - Sang Woo Kim
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | | | | | - Hyun Jin Kim
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | - Man Woo Park
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | | | - Ja-Il Koo
- Coloproctology Center, Goo Hospital, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University School of Medicine, Daegu, Korea
| | - Dae Ho Shon
- Hwanggeumbit Hakmoon Colorectal Surgery Clinic, Daegu, Korea
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Abstract
Adequate bowel preparation is essential for optimal colonoscopy. Suboptimal bowel preparation occurs in 25% to 40% of cases and is associated with canceled procedures, prolonged procedure time, incomplete examination, increased cost, and missed pathology. There are several effective formulations for colon cleansing with a good safety profile. Split dosing should be implemented whenever possible in an effort to enhance tolerance and adherence, and improve mucosal visibility and overall quality of the examination. In this review, modern bowel preparations are discussed including their mechanism of action, mode of use, safety, and how to optimize outcomes.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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