Severe Hyponatraemia and Associated Seizure Following the Administration of Sodium Picosulfate/Magnesium Citrate (Picolax): A Case Report

Abstract

Bowel preparation is known to cause minor electrolyte disturbances. We report the case of a patient with severe hyponatraemia and hypokalaemia, resulting in a seizure, following the administration of picolax. A 60 year old female patient with no significant past medical history and taking no regular medications presented with confusion following administration of picolax for an elective colonoscopy. On arrival her GCS was 14/15 but moments later she had a tonic-clonic seizure, with no urinary incontinence or tongue biting lasting two minutes. Following this, her GCS was 9/15. Laboratory tests revealed a sodium level of 119 mmol/L and a potassium level of 3.1 mmol/L. Other investigations including CT head and lumbar puncture were normal. Following intravenous replacement of electrolytes, her electrolytes improved and GCS returned to 15/15. Severe hyponatraemia, hypokalaemia and associated seizures following bowel preparation are rarely described in the literature. There are only five reported cases of severe electrolyte disturbances following bowel preparation that have caused seizures. We urge care to be taken when prescribing bowel preparation; particularly in those with pre-existing medical conditions and taking medications which can cause hyponatreamia, and to council patients when prescribing bowel preparation on the side effects.