CRCM  Vol.3 No.2 , February 2014
Acute symptomatic hyponatraemia following sodium picosulfate/magnesium citrate as bowel preparation for colonoscopy—A case series
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.
Cite this paper: Forde, H. , O’Shea, T. , Davenport, C. and Smith, D. (2014) Acute symptomatic hyponatraemia following sodium picosulfate/magnesium citrate as bowel preparation for colonoscopy—A case series. Case Reports in Clinical Medicine, 3, 101-104. doi: 10.4236/crcm.2014.32025.

[1]   Jauch, R., Hankwitz, R., Beschke, K. and Pelzer, H. (1975) Bis-(p-hydroxyphenyl)-pyridyl-2-methane: The common laxative principle of bisacodyl and sodium picosulfate. Arzneimittel-Forschung, 25, 1796.

[2]   Regev, A., Fraser, G. and Delpre, G. (1998) Comparison of two bowel preparations for colonoscopy: Sodium picosulphate and magnesium citrate versus sulphate free polyethylene glycol lavage solution. American Journal of Gastroenterology, 93, 1478-1482.

[3]   Ryan, F., Anobile, T., Scutt, D., Hopwood, M. and Murphy, G. (2005) Effects of oral sodium picosulphate Picolax on urea and electrolytes. Nursing Standard (Royal College of Nursing (Great Britain)), 19, 41.

[4]   Frizelle, F.A. and Colls, B.M. (2005) Hyponatremia and seizures after bowel preparation: Report of three cases. Diseases of the Colon and Rectum, 48, 393-396.

[5]   Dillon, C.E. and Laher, M.S. (2009) The rapid development of hyponatraemia and seizures in an elderly patient following sodium picosulfate/magnesium citrate (Picolax). Age and Ageing, 38, 487-487.

[6]   Cohen, C.D., Keuneke, C., Schiemann, U., Schroppel, B., Siegert, S., Rascher, W., et al. (2001) Hyponatraemia as a complication of colonoscopy. The Lancet, 357, 282-283.

[7]   Smith, D.M., McKenna, K. and Thompson, C.J. (2000) Hyponatraemia. Clinical Endocrinology (Oxf), 52, 667-678.

[8]   Dig, R.E.E. (2013) Severe rhabdomyolysis and hyponatremia induced by picosulfate and bisacodyl during the preparation of colonoscopy. Revista Española de Enfermedades Digestivas, 105, 180-182.

[9]   Chen, H., Chen, C., Chu, P., Chao, P. and Lin, S. (2006) Acute hyponatremic encephalopathy after preparation for colonoscopy. Journal of Medical Sciences-Taipei, 26, 33.