Bowel preparation in CT colonography: electrolyte and renal function disturbances in the frail and elderly patient

Laughlin, Patrick Mc; Eustace, Joseph A.; Sweeney, Sean Mc; Williams, Sebastian Mc; O’Regan, Kevin; OʼConnor, Michael; Kelly, Denis; Maher, Michael M.

doi:10.1007/s00330-009-1575-3

Cited by 17 publications

(13 citation statements)

References 22 publications

(27 reference statements)

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“…The respective summary of product characteristics for each of the individual magnesium-based preparations advocates the use of alternative preparations in patients with ‘severely reduced renal function’. In a recent study of 72 older patients with a mean estimated GFR of 60.8 ml/min per 1.73 m 2 and receiving sodium picosulphate with magnesium citrate (Picolax) before CT colonoscopy, serum magnesium levels were measured before and after the administration of Picolax in 14 patients 26. Although without clinical sequelae in this study, three patients experienced an increase in serum magnesium in excess of 0.25 mmol/l.…”

Section: Introductionmentioning

confidence: 80%

“…This risk is likely to be greatest with sodium phosphate preparations, but also exists with sodium picosulphate (although a recent study of 72 patients receiving Picolax before CT colonoscopy revealed no significant changes in estimated glomerular filtration rate (GFR)26); the risk of hypovolaemia is least with polyethylene glycol preparations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents

Connor

Tolan

Hughes

et al. 2012

Gut

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Section: Introductionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents

Connor

Tolan

Hughes

et al. 2012

Gut

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“…In one small prospective study (20 healthy volunteers aged < 65 years) investigators found a disturbance of serum magnesium, whereas sodium, phosphate as well as renal parameters stayed within the normal ranges . In a retrospective study on 72 elderly patients of which 13 suffered from chronic kidney failure, no disturbance of sodium, potassium, or renal parameters were found after undergoing colon cleansing with PMC for computed tomography (CT) colonography . Another small prospective study comparing PEG and PMC in 65 patients showed no relevant electrolyte or osmolality shifts .…”

Section: Discussionmentioning

confidence: 99%

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

Klare

Poloschek

Walter

et al. 2015

J of Gastro and Hepatol

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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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“…Commonly documented side effects include abdominal discomfort and nausea [17][18][19]. Potentially serious adverse events are rare and include vasovagal reactions, electrolyte disturbances, angina and perforation [18,20]. The reported potentially serious adverse event and overall perforation rates are 0.08% and 0.05% respectively [18].…”

Section: Discussionmentioning

confidence: 99%

CT colonography and transient bacteraemia: implications for antibiotic prophylaxis

et al. 2010

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American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC.

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Bowel preparation in CT colonography: electrolyte and renal function disturbances in the frail and elderly patient

Abstract: In our group CTC with SPS-MC was safe and effective; however, we advise an alternate preparation be considered in patients with decreased renal function due to decreased magnesium clearance.

Cited by 17 publications

References 22 publications

Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents

Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

CT colonography and transient bacteraemia: implications for antibiotic prophylaxis

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