Skip to main content
SpringerLink
Log in

Hyponatremia and Seizures After Bowel Preparation: Report of Three Cases

  • Case Reports
  • Published:
Diseases of the Colon & Rectum

Oral sodium phosphate and sodium picosulfates/magnesium citrate are commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. These substances, however, are known to cause electrolyte abnormalities. Seizures caused by electrolyte abnormalities associated with bowel preparation have only rarely been reported. We report the cases of three patients with no prior history of seizures, who had their first seizure associated with hyponatremia following ingestion of sodium phosphate or sodium picosulfates/magnesium citrate combination. Care must be taken with patients with a low seizure threshold and those with possible chronic sodium depletion, such as patients on thiazide diuretics, who are undertaking bowel preparation with oral sodium phosphate or sodium picosulfates/magnesium citrate combination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. AC Mackey D Shaffer R Prizant (2002) ArticleTitleSeizure associated with the use of Viscol for colonoscopy N Engl J Med 346 2095 Occurrence Handle12087153

    PubMed  Google Scholar 

  2. SM Cohen SD Wexner SR Binderow et al. (1994) ArticleTitleProspective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleaning methods Dis Colon Rectum 37 689–96 Occurrence Handle1:STN:280:DyaK2c3pvVCiuw%3D%3D Occurrence Handle8026236

    CAS  PubMed  Google Scholar 

  3. A Regev G Fraser G Delpre et al. (1998) ArticleTitleComparison of two bowel preparations for colonoscopy: sodium picosulphate and magnesium citrate versus sulphate free polyethylene glycol lavage solution Am J Gastroenterol 93 1478–82 Occurrence Handle9732929 Occurrence Handle1:CAS:528:DyaK1cXmtFSnu7k%3D

    PubMed  CAS  Google Scholar 

  4. CJ Young RR Simpson DW King DZ Lubowski (2000) ArticleTitleOral sodium phosphate solution is a superior colonoscopy preparation to polyethylene glycol with bisacodyl Dis Colon Rectum 43 1568–71 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt1GitA%3D%3D Occurrence Handle11089594

    CAS  PubMed  Google Scholar 

  5. AP Chilton M O’sullivan MA Cox DE Loft CU Nwokolo (2000) ArticleTitleA blinded, randomised comparison of a novel, low-dose, triple regimen with Fleet Phospo-Soda: a study of colon cleanliness, speed and success of colonoscopy Endoscopy 32 37–41 Occurrence Handle1:STN:280:DC%2BD3c7ltlWhuw%3D%3D Occurrence Handle10691270

    CAS  PubMed  Google Scholar 

  6. G Sanders SJ Mercer K Saeb-Parsey MA Akhavani KB Hosie AW Lambert (2001) ArticleTitleRandomised clinical trial of intravenous fluid replacement during bowel preparation for surgery Br J Surg 88 1363–5 Occurrence Handle11578293 Occurrence Handle1:STN:280:DC%2BD3Mrjt1Smsg%3D%3D

    PubMed  CAS  Google Scholar 

  7. T Egesel B Sivri M Asik B Altun Y Bayraktar (2000) ArticleTitleA fatal complication of sodium-phosphate enema Turk J Gastroenterol 11 338–40

    Google Scholar 

  8. P Campisi V Badhwar S Morin JL Trudel (1999) ArticleTitlePostoperative hypocalcemic tetany caused by fleet phospho-soda preparation in a patient taking alendronate sodium: report of a case Dis Colon Rectum 42 1499–501 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyiug%3D%3D Occurrence Handle10566542

    CAS  PubMed  Google Scholar 

  9. M Orias RL Mahnensmith MA Perazella (1999) ArticleTitleExtreme hyperphosphatemia and acute renal failure after phosphorous-containing bowel regimen Am J Nephrol 19 60–3 Occurrence Handle1:STN:280:DyaK1M7os12quw%3D%3D Occurrence Handle10085452

    CAS  PubMed  Google Scholar 

  10. R Edwards M Mitchell S Twaddle (1998) ArticleTitleHypophosphataemia in the critically ill patient-aetiology and management Care Critically Ill 14 267–70

    Google Scholar 

  11. MP Soumoy A Bachy (1998) ArticleTitleSevere phosphate enema poisoning in an infant Arch Pediatr 5 1221–3 Occurrence Handle1:STN:280:DyaK1M%2FntVWksA%3D%3D Occurrence Handle9853060 Occurrence Handle10.1016/S0929-693X(98)81238-4

    Article  CAS  PubMed  Google Scholar 

  12. H Bozkaya H Ozturk Y Uzun A Ozden (1997) ArticleTitleEfficiency and safety of oral sodium phosphate cleansing Turk J Gastroenterol 8 217–21 Occurrence Handle10.1159/000106634

    Article  Google Scholar 

  13. SS Post (1997) ArticleTitleHyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (Fleet) enema intoxication J Clin Gastroenterol 24 192 Occurrence Handle9179745 Occurrence Handle1:STN:280:DyaK2szitlamtA%3D%3D

    PubMed  CAS  Google Scholar 

  14. ED Ehrenpresis JM Wieland J Cabral V Estevez D Zaitman K Secrest (1997) ArticleTitleSymptomatic hypocalcemia, hypomagnesemia, and hyperphosphatemia secondary to Fleets Phospho-Soda colonoscopy preparation in a patient with a jejunoileal bypass Dig Dis Sci 42 858–60 Occurrence Handle9125662

    PubMed  Google Scholar 

  15. P Vukasin LA Weston RW Beart (1997) ArticleTitleOral Fleet® Phospho-Soda® laxative-induced hyperphosphatemia and hypocalcemic tetany in an adult: report of a case Dis Colon Rectum 40 497–9 Occurrence Handle1:STN:280:DyaK2s3mtVGrsQ%3D%3D Occurrence Handle9106703

    CAS  PubMed  Google Scholar 

  16. AM Lambert RJ Herman (1996) ArticleTitleToxicity due to hypertonic sodium phosphate (Fleet) enema: approach to the constipated patient Can J Clin Pharmacol 3 139–44

    Google Scholar 

  17. MA Boivin SR Kahn (1998) ArticleTitleSymptomatic hypocalcemia from oral sodium phosphate: report of two cases Am J Gastroenterol 93 2577–9 Occurrence Handle9860431 Occurrence Handle1:STN:280:DyaK1M%2FnsFOktg%3D%3D

    PubMed  CAS  Google Scholar 

  18. ED Ehrenpris JJ Nogeras VA Botoman GF Bonner D Zaitman KM Secrest (1996) ArticleTitleSerum electrolyte abnormalities secondary to Fleet’s Phospo-Soda colonoscopy prep: a review of three cases Surg Endosc 10 1022–4 Occurrence Handle8864100

    PubMed  Google Scholar 

  19. T Huynh S Vanner W Paterson (1995) ArticleTitleSaftey profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing lack of clinically significant hypocalcemia or hypovolemia Am J Gastroenterol 90 104–7 Occurrence Handle1:STN:280:DyaK2M7gtVWmug%3D%3D Occurrence Handle7801907

    CAS  PubMed  Google Scholar 

  20. JA DiPalma SE Buckley BA Warner RM Culpepper (1996) ArticleTitleBiochemical effects or oral sodium phosphate Dig Dis Sci 41 749–53 Occurrence Handle8674396 Occurrence Handle1:CAS:528:DyaK28XivF2jt7w%3D

    PubMed  CAS  Google Scholar 

  21. B Knobel P Petchenko (1996) ArticleTitleHyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (Fleet) enema intoxication J Clin Gastroenterol 23 217–9 Occurrence Handle8899506 Occurrence Handle1:STN:280:DyaK2s%2FlsFaiuw%3D%3D

    PubMed  CAS  Google Scholar 

  22. AJP Filho MN Lassman (1996) ArticleTitleSevere hyperphosphatemia induced by a phosphate-containing oral laxative Ann Pharmacother 30 141–3 Occurrence Handle8835046 Occurrence Handle1:STN:280:DyaK28vjtF2rsg%3D%3D

    PubMed  CAS  Google Scholar 

  23. R Fass S Do LJ Hixson (1993) ArticleTitleFatal hyperphosphatemia following Fleet Phospo-Soda in a patient with colonic ileus Am J Gastroenterol 88 929–32 Occurrence Handle8503390 Occurrence Handle1:STN:280:DyaK3s3ns1yhsA%3D%3D

    PubMed  CAS  Google Scholar 

  24. A Korzets D Dicker C Chaimoff D Zevin (1992) ArticleTitleLife-threatening hyperphosphatemia and hypocalcemic tetany following the use of Fleet enemas J Am Geriatr Soc 40 620–1 Occurrence Handle1:STN:280:DyaK383mvVemtg%3D%3D Occurrence Handle1587983

    CAS  PubMed  Google Scholar 

  25. S Wason T Tiller C Cunha (1989) ArticleTitleSevere hyperphosphatemia, hypocalcemia, acidosis, and shock in a 5-month-old child following administration of an adult Fleet enema Ann Emerg Med 18 696–700 Occurrence Handle1:STN:280:DyaL1M3ntFajtw%3D%3D Occurrence Handle2729698

    CAS  PubMed  Google Scholar 

  26. Baxter Healthcare. Fleet Phospho-soda Buffered Saline Mixture; Data Sheet. Information for Health Professionals. Available at: www.medsafe.govt.nz/Profs/Datasheet/f/fleetphosphosoln.htm (accessed 01/01/2003).

  27. AG Hill A Still BR Parry LD Plank GL Hill (1998) ArticleTitleCellular potassium depletion predisposes to hypokalaemia after oral sodium phosphate ANZ J Surg 68 856–8 Occurrence Handle1:STN:280:DyaK1M7gtV2muw%3D%3D

    CAS  Google Scholar 

  28. EH Kossoff MT Silvia A Maret M Carakushansky EP Vining (2002) ArticleTitleNeonatal hypocalcemic seizures: case report and literature review J Child Neurol 17 236–9 Occurrence Handle12026245

    PubMed  Google Scholar 

  29. H Caksen D Odabas S Sar et al. (2001) ArticleTitleHyponatremic dehydration: an analysis of 78 cases Int Urol Nephrol 33 445–8 Occurrence Handle1:CAS:528:DC%2BD38XnvF2ju7o%3D Occurrence Handle12230268

    CAS  PubMed  Google Scholar 

  30. P Bhalla FE Eaton JB Coulter FL Amegavine JA Stills LJ Abernethy (1999) ArticleTitleHyponatraemic seizures and excessive intake of hypotonic fluids in young children BMJ 319 1554–7 Occurrence Handle1:STN:280:DC%2BD3c%2FlvFCltw%3D%3D Occurrence Handle10591722

    CAS  PubMed  Google Scholar 

  31. B Basnyat J Sleggs M Spinger (2000) ArticleTitleSeizures and delirium in a trekker: the consequences of excessive water drinking? Wilderness Environ Med 11 69–70 Occurrence Handle10731911 Occurrence Handle1:STN:280:DC%2BD3c7ps1Clsg%3D%3D

    PubMed  CAS  Google Scholar 

  32. JC Ayus AI Arieff (1996) ArticleTitleAbnormalities of water metabolism in the elderly Semin Nephrol 16 277–88 Occurrence Handle1:STN:280:DyaK28vislSjug%3D%3D Occurrence Handle8829266

    CAS  PubMed  Google Scholar 

  33. S Fritz P Mi-Plaza MH Hust HJ Bugler B Braun (1994) ArticleTitleA rare cause of hyponatremia: self-induced water intoxication Med Klin 89 283–5 Occurrence Handle1:CAS:528:DyaK2MXitFChsQ%3D%3D Occurrence Handle8052185

    CAS  PubMed  Google Scholar 

  34. P Pais (1993) ArticleTitleDiuretic induced hyponatraemia in the elderly J Assoc Physicians India 41 228

    Google Scholar 

  35. Adverse Event Reporting System (AERS). Rockville, Md: Center for Drug Evaluation and Research, Food and Drug Administration. Available at: www.fda.gov/cder/aers/default.htm (accessed 01/01/2003).

Download references

Author information

Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand

    F. A. Frizelle M.B.Ch.B. , M.Med.Sc. , F.R.A.C.S.

  2. Department of Medicine, Christchurch Hospital, Christchurch, New Zealand

    B. M. Colls M.B.Ch.B. , F.R.A.C.P., F.R.C.P.

Authors
  1. F. A. Frizelle M.B.Ch.B. , M.Med.Sc. , F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. M. Colls M.B.Ch.B. , F.R.A.C.P., F.R.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. A. Frizelle M.B.Ch.B. , M.Med.Sc. , F.R.A.C.S..

Additional information

Reprints are not available.

About this article

Cite this article

Frizelle, F., Colls, B. Hyponatremia and Seizures After Bowel Preparation: Report of Three Cases. Dis Colon Rectum 48, 393–396 (2005). https://doi.org/10.1007/s10350-004-0778-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0778-6

Key words

Search

Navigation