Advertisement

Diseases of the Colon & Rectum

, Volume 47, Issue 9, pp 1397–1402 | Cite as

Physiologic Effects of Bowel Preparation

  • Kathrine HolteEmail author
  • Kristine Grubbe Nielsen
  • Jan Lysgård Madsen
  • Henrik Kehlet
Original Contributions

PURPOSE:

Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation.

METHODS:

In a prospective study, 12 healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance, plasma and extracellular volume, balance function, and biochemical parameters were measured.

RESULTS:

Bowel preparation led to a significant decrease in exercise capacity (median, 9 percent) and weight (median, 1.2 kg). Plasma osmolality was significantly increased from 287 to 290 mmol kg−1, as well as increased phosphate and urea concentrations, whereas calcium and potassium concentrations decreased significantly after bowel preparation. No differences in plasma or extracellular volumes were seen. Orthostatic tolerance and balance function did not change after bowel preparation.

CONCLUSIONS:

Bowel preparation has significant adverse physiologic effects, which may be attributed to dehydration. The majority of these findings is small and may not be of clinical relevance in otherwise healthy patients undergoing bowel preparation and following recommendations for oral fluid intake.

Keywords

Bowel preparation Dehydration Exercise capacity Extracellular volume Plasma volume 

REFERENCES

  1. 1.
    Zmora, O, Pikarsky, AJ, Wexner, SD 2001Bowel preparation for colorectal surgeryDis Colon Rectum44153749PubMedGoogle Scholar
  2. 2.
    Kutt, E, Hall, MJ, Booth, A, Virjee, J 1988Barium enemas are a headacheClin Radiol39910PubMedGoogle Scholar
  3. 3.
    Barker, P, Trotter, T, Hanning, C 1992A study of the effect of Picolax on body weight, cardiovascular variables and haemoglobin concentrationAnn R Coll Surg Engl743189PubMedGoogle Scholar
  4. 4.
    Kjaersgaard, M, Lie, C, Bisgaard, T, Kehlet, H, Rosenberg, J 2000Effect of oxygen on postoperative cardiovascular response to exerciseEur J Surg1669159PubMedGoogle Scholar
  5. 5.
    Holte, K, Jensen, P, Kehlet, H 2003Physiologic effects of intravenous fluid administration in healthy volunteersAnesth Analg9615049PubMedGoogle Scholar
  6. 6.
    Brochner-Mortensen, J 1972A simple method for the determination of glomerular filtration rateScand J Clin Lab Invest302714PubMedGoogle Scholar
  7. 7.
    Brochner-Mortensen, J 1980A simple single injection method for determination of the extracellular fluid volumeScand J Clin Lab Invest4056773PubMedGoogle Scholar
  8. 8.
    Lieberman, DA, Ghormley, J, Flora, K 1996Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinineGastrointest Endosc434679PubMedGoogle Scholar
  9. 9.
    Dipalma, JA, Buckley, SE, Warner, BA, Culpepper, RM 1996Biochemical effects of oral sodium phosphateDig Dis Sci4174953PubMedGoogle Scholar
  10. 10.
    Toledo, TK, Dipalma, JA 2001Colon cleansing preparation for gastrointestinal proceduresAliment Pharmacol Ther1560511PubMedGoogle Scholar
  11. 11.
    Sanders, G, Mercer, SJ, Saeb-Parsey, K, Akhavani, MA, Hosie, KB, Lambert, AW 2001Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgeryBr J Surg8813635PubMedGoogle Scholar
  12. 12.
    Huynh, T, Vanner, S, Paterson, W 1995Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemiaAm J Gastroenterol901047PubMedGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2004

Authors and Affiliations

  • Kathrine Holte
    • 1
    Email author
  • Kristine Grubbe Nielsen
    • 1
  • Jan Lysgård Madsen
    • 2
  • Henrik Kehlet
    • 1
  1. 1.Department of Surgical GastroenterologyHvidovre University HospitalDenmark
  2. 2.Department of Clinical PhysiologyHvidovre University HospitalDenmark

Personalised recommendations