Hyponatremia and Sodium Picosulfate Bowel Preparations in Older Adults

Weir, Matthew A.; Fleet, Jamie L.; Vinden, Chris; Shariff, Salimah Z.; Liu, Kuan; Song, Haoyuan; Jain, Arsh K.; Gandhi, Sumeet; Clark, William F.; Garg, Amit X.

doi:10.1038/ajg.2014.20

Cited by 51 publications

(34 citation statements)

References 37 publications

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“…However, in one recent large retrospective investigation, hospitalizations with hyponatremia were studied in patients who had received either sodium picosulfate or PEG prescriptions for colonoscopy within 30 days before hospital admission. There were significantly more hospitalizations in the picosulfate group compared with PEG . Although no severe adverse events occurred during our investigation, data support the assumption that patients treated with PMC are at increased risk for electrolyte disturbances, which might result in clinically significant hyponatremia.…”

Section: Discussionsupporting

confidence: 73%

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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Section: Discussionsupporting

confidence: 73%

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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“…A split‐dose bowel preparation for all patients or same day preparation for afternoon colonoscopy has been recommended in recent guidelines 28. Although well tolerated and safe in most, there is a small increased risk of hyponatremia with SPMC in the elderly29 and, therefore, PEG‐based bowel preparation may be more appropriate in these patients.…”

Section: Discussionmentioning

confidence: 99%

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

et al. 2017

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Background and AimBowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low‐residue White Diet and low‐volume, split‐dose Picosalax with the standard preparation at our institution of day‐before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).MethodsAdults undergoing morning colonoscopy were randomized to either the White Diet and split‐dose, two sachets of Picosalax (WD/PICO) or day‐before clear fluids and 1‐L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy.ResultsA total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non‐inferior to CF/PEG + SPMC for successful bowel preparation by intention‐to‐treat analysis (58% WD/PICO vs 62% CF/PEG + SPMC, 95%CI: −14.2 to 6.2%) and per‐protocol analysis (64% WD/PICO vs 65% CF/PEG + SPMC, 95%CI: −11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet (P < 0.001), greater ease of following the diet (P < 0.001), and improved experience compared with prior colonoscopy (P < 0.0001), less bloating (P = 0.02), less weakness (P = 0.046), less hunger (P < 0.0001), and less interference with daily activities (P = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.ConclusionBowel preparation with the White Diet and low‐volume, split‐dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.

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“…We also expected urgent CT scans of the head conducted for reasons unrelated to antiviral dosing to occur at a similar frequency in higher and lower dose groups; therefore, not impacting estimates of difference in risk. We have used this outcome of urgent CT scans of the head in other population-based drug safety studies to characterize the risk of drug-induced delirium [33]. Our secondary outcome was all-cause mortality.…”

Section: Methodsmentioning

confidence: 99%

Higher dose versus lower dose of antiviral therapy in the treatment of herpes zoster infection in the elderly: a matched retrospective population-based cohort study

Lam

Fleet

McArthur

et al. 2014

BMC Pharmacol Toxicol

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BackgroundHigher versus lower doses of antiviral drugs used to treat herpes zoster infection may lead to more adverse drug events in older adults, particularly those with chronic kidney disease.MethodsWe conducted a matched retrospective population-based cohort study of older adults (mean 77 years) in Ontario, Canada who initiated in the outpatient setting a higher (n = 23,256) or lower (n = 3,876) dose of one of three oral antivirals for the treatment of herpes zoster between 2002 and 2011. The primary outcome was hospitalization within 30 days with evidence of a computed tomography (CT) scan of the head (a proxy for acute neurotoxicity). The secondary outcome was 30-day all-cause mortality.ResultsA higher compared to lower dose of antiviral drug was not associated with an increased risk of hospitalization with an urgent CT scan of the head (247 [1.06%] events with higher dose versus 43 [1.11%] events with lower dose, relative risk 0.96, 95% confidence interval 0.69 to 1.33, p-value 0.79) and was not associated with a higher risk of all-cause mortality (63 [0.27%] events versus 15 [0.39%] events, relative risk 0.70, 95% confidence interval 0.40 to 1.23, p-value 0.21). Results were consistent in all subgroups, including those with and without chronic kidney disease.ConclusionsInitiating a higher compared to a lower dose of an antiviral drug for the treatment of herpes zoster was not associated with an increased risk of adverse drug events. The findings support the safety of these drugs in older adults as currently prescribed in routine care.

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Hyponatremia and Sodium Picosulfate Bowel Preparations in Older Adults

Cited by 51 publications

References 37 publications

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

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

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

Higher dose versus lower dose of antiviral therapy in the treatment of herpes zoster infection in the elderly: a matched retrospective population-based cohort study

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