Oral Sodium Phosphate Solution Research Articles

PREVALENCE OF HYPOKALEMIA AFTER BOWEL PREPARATION IN PATIENTS UNDERGOING COLORECTAL INTERVENTIONS

INTRODUCTION:-Bowel preparation is usually done before colonoscopy and other colorectal interventions. It mostly contain oral sodium phosphate or polyethylene glycol solutions.. Bowel preparation results in electrolyte shifts, requiring special precautions especially in high risk patients. It causes abdominal distension ( ileus), muscle cramps , arrhythmia, hypokalemia.This study is undertaken to determine the electrolyte imbalances and clinical outcome of the patient who underwent bowel preparation and colorectal intervention. MATERIAL AND METHODS:- We conducted our study in Department of General Surgery, Dr. B. R. A. M. Hospital Raipur C.G. over a period of 1 year.Written and informed consent was taken from all the patients. This study is hospital based,cross sectional observational study.Patient was given two liters polyethylene glycol based solution which contain polyethylene glycol,sodium chloride,potassium chloride,sodium bicarbonate,and anhydrous sodium sulfate for bowel cleansing and asked to drink the solution in 2 hrs and to feed on only clear fluids. We compared serum potassium levels before and after bowel preparation and evaluated the development of hypokalemia after bowel preparation. RESULTS:- The study was done among 71 patients who underwent bowel preparation before colorectal intervention at Dr.B.R.A.M. hospital Raipur (C.G.) in one year. 36.6% of the participants developed mild hypokalemia after bowel preparation. Most of the patients belong to age group of 41-50 years(26.8%). The duration of passage of first flatus and first feces after intervention was longer in patient with hypokalemia (1.73 and 3.30) as compared to patient with normokalemia (0.87 and 1.26). CONCLUSION :-On the basis of our study it is evident that hypokalemia can develop after bowel preparation in patients who underwent colorectal interventions.

Randomized Controlled Trial of Polyethylene Glycol versus Oral Sodium Phosphate for Bowel Preparation in Unsedated Colonoscopy.

Aim To identify the most effective laxative for bowel preparation in unsedated colonoscopy. Methods Between April 2019 and April 2020, a total of 586 outpatients scheduled for unsedated colonoscopy at the First Hospital of Jilin University (Changchun, China) were randomized into one of two groups, namely, the polyethylene glycol (PEG) group or the oral sodium phosphate solution (OSP) group. The cleaning efficiency and other relevant clinical parameters were compared between the two groups. Results Each group consisted of 293 patients. There were no significant differences in gender, body mass index, and history of abdominal surgery between the two groups. There were more cases of laxative intolerance in the PEG group than in the OSP group (7.5% vs. 0.7%, P < 0.05). After tube insertion, we found that the cleaning efficiency of OSP was better than that of PEG (P < 0.05). After cleaning, there was no significant difference in bowel cleanliness between the two groups (P > 0.05). The colonoscopic insertion time of the PEG group was significantly shorter than that of the OSP group (10.0 vs. 12.0 min, P = 0.002), and colonoscopic insertion was more difficult in the OSP group than in the PEG group (P = 0.036). The VAS score of the PEG group patients was significantly lower than that of OSP group patients (4.0 ± 1.3 vs. 5.2 ± 1.7, P ≤ 0.001). There were no significant differences in the cecal intubation rate and the detection rate of polyps and ulcers/erosion between the two groups. Conclusion The cleaning efficiency and tolerability of OSP were preferable to those of PEG, but there was no significant difference in bowel cleanliness after washing the colon and suctioning the fluid. Compared with patients of the OSP group, those of the PEG group required a shorter colonoscopic insertion time and reported a more comfortable experience. Therefore, for cases that are tolerant of PEG, PEG is a better choice for unsedated colonoscopy.

The diagnostic yield and risk of screening colonoscopy in geriatric subjects older than 80 years

AbstractThe aim of the study is to evaluate the diagnostic yield and risks of screening colonoscopy in octogenarians and older. A retrospective review of medical records in the Chang Gung Healthcare Center from January 2010 to December 2016 was performed. A total of 164 adults older than 80 years receiving screening colonoscopy were enrolled. Cecal intubation rate, colonoscopic finding, renal function, colon preparation, and procedure‐related complications were used to estimate the outcome of colonoscopy. All participants were under deep sedation. The crude cecal intubation rate was 95%. Acceptable colon preparation was 95.1%. No procedure‐related complications, such as bleeding or perforation, occurred in this study. The level of creatinine increasing more than 25% were two (6.3%) in polyethylene glycol group and 10 (16.1%) in oral sodium phosphate solution (NaP) group. The colonoscopic finding were as follows: 19 advanced neoplasms (11.5%), 56 non‐advanced adenomas (34.1%), and 38 hyperplastic polyps (23.2%). This study disclosed the diagnostic yield and safety of colonoscopy in octogenarians and older. In addition, we should be cautious when giving NaP to these subjects.

Do We Need Mechanical Bowel Preparation before Benign Gynecologic Laparoscopic Surgeries A Randomized, Single-Blind, Controlled Trial

Aims: The primary objective of this study was to compare the effect of mechanical bowel preparation (MBP) with oral sodium phosphate (NaP) solution vs. MBP with NaP enema vs. fasting only with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery in patients undergoing benign gynecologic laparoscopic procedures. Methods: The patients were randomized into one of 3 groups: oral NaP, NaP enema, or fasting only. The primary surgeon and assistant(s) remained blinded to the randomization assignments. Intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery were assessed using a surgeon questionnaire based on Visual Analog Scales. Results: We enrolled 293 women, of whom 278 were randomized to receive oral NaP solution (n = 96), undergo NaP enema (n = 92), or perform fasting only (n = 90). No significant differences were found between the 3 groups. Conclusions: No differences were observed among patients who underwent MBP with oral NaP or NaP enema and those without MBP, with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery. No benefit of MBP was found when removing large uteri or when operating on patients with a high body mass index.

Phosphate enemas and GFR decline: it’s premature to sound the alarm

Oral sodium phosphate solutions can cause acute phosphate nephropathy, resulting in acute kidney injury and chronic kidney disease. A recent cohort study suggests that phosphate enemas may also be associated with a decline in glomerular filtration rate, but further study is needed to establish a causal relationship.

Kidney injury after sodium phosphate solution beyond the acute renal failure

Background and objectivesScreening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. MethodsFrom 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. ResultsWe analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m2. ConclusionsThe use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury.

Kidney injury after sodium phosphate solution beyond the acute renal failure

Background and objectivesScreening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. MethodsFrom 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. ResultsWe analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m2. ConclusionsThe use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury.

An Uncommon Potentially Fatal Complication in a Patient without Predisposing Factor Following Oral Bowel Preparation Commonly Used for Colonoscopy

We described the case report of a patient presented with no known predisposing factor, generalized malaise with vomiting, locked jaw, perioral paraesthesia, carpopedal spasm and a positive Chvostek’s sign which resulted from severe electrolyte disturbance at 5 hours after use of oral sodium phosphate solution (NaPO4) as bowel preparation for colonoscopy. On presentation, she developed hyperphosphatemia and symptomatic hypocalcaemia with serum phosphate of 1.84 mmol/L and adjusted calcium level 1.67 mmol/L respectively. Her symptoms subsided after immediate intravenous calcium gluconate followed by oral calcium supplement. The electrolyte disturbances were normalized with an uneventful clinical course. The potentially fatal complications of sodium phosphate solution which commonly prescribed as bowel preparation for conventional colonoscopy could develop though previously reported as uncommon in patients without predisposing factors, and should not be overlooked. Urgent assessment and immediate correction of electrolyte disturbances are needed. Recommendations on patient selection of use of sodium phosphate to minimize risk of developing adverse events are needed to incorporate in clinical protocols.

Effects of oral sodium phosphate solution, as a colonpreparation agent, on the serum potassium levelin patients undergoing colonoscopy at aSecondary Care Community Hospital

Effects of oral sodium phosphate solution, as a colonpreparation agent, on the serum potassium levelin patients undergoing colonoscopy at aSecondary Care Community Hospital

Colonoscopy preparation-induced disorders in renal function and electrolytes

Colonoscopy and flexible sigmoidoscopy are commonly used mainly for colon cancer screening and detection, but also in several other situations such as inflammatory bowel disease (for diagnosis and follow up) and gastrointestinal hemorrhage. Bowel cleansing preparations mainly include polyethylene glycol and oral sodium phosphate solutions, with the later being most frequently used due to better toleration from patients. Despite their favourable safety profile these agents have been associated with renal function deterioration and electrolyte disorders, some of which were serious or even fatal. The present paper discusses the complications associated with colonoscopy preparation agents.

A brief grief over bowel relief

Oral sodium phosphate (OSP) solution is commonly used as bowel purgative before colonoscopy. Its safety has recently been questioned with several reports of acute renal failure and chronic kidney disease following its use. All of the cases reported are following bowel preparation for colonoscopy. I present a case of acute renal failure following OSP solution given to relieve constipation. This report further highlights the dangers of OSP and the importance of caution and careful monitoring when OSP solution is used as a cathartic, or for bowel preparation before colonoscopy.

A case of biopsy-proven chronic kidney disease on progression from acute phosphate nephropathy

Acute phosphate nephropathy (APhN) following oral sodium phosphate solution (OSP) ingestion as a bowel purgative has been frequently reported. It was recently suggested that APhN could progress to chronic kidney disease (CKD) and a history of APhN might be considered as one of the causes of CKD. However, there are few reports proving APhN as a cause of CKD. Here, we report a case of APhN that progressed to CKD, as proven by renal biopsy.

Findings of Biopsy-Proven Chronicity and End-Stage Renal Failure Associated with Oral Sodium Phosphate Solution

Bowel purgatives containing oral sodium phosphate (OSP) solution are used frequently in general practice and they have the potential of causing acute kidney injury especially in patients with some identified risk factors. Kidney injury may lead to chronicity and end-stage renal disease. Here we present, with renal biopsy findings, an elderly patient suffering from end-stage renal failure due to OSP solution.

Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation

To evaluate the efficacy and acceptability of magnesium citrate and a single dose of oral sodium phosphate (45 mL) solution for morning colonoscopy bowel preparation. A total of 159 patients were randomly assigned to receive two split doses of 90 mg of sodium phosphate (Group I, n = 79) or magnesium citrate (250 mL, the day before the procedure) followed by 45 mL of sodium phosphate (the day of procedure, Group II, n = 80). The quality of bowel cleansing and the acceptability of each regimen were compared, including the satisfaction, taste, willing to repeat and adverse effects of each regimen. The quality of bowel cleansing of Group II was as good as that of Group I (An Aronchick scale score of good or excellent: 70.9% vs 81.0%, respectively, P = 0.34; the Ottawa system score: 4.4 ± 2.6 vs 3.8 ± 3.0, respectively, P = 0.76). There was no statistically significant difference between both groups with regard to acceptability, including the satisfaction, taste and willingness to repeat the regimen. A significantly greater number of older patients (over 65 years old) in Group II graded the overall satisfaction as satisfactory (48.1% vs 78.1%, respectively; Group I vs Group II, P = 0.01). There were no significant adverse reactions. Magnesium citrate and a single dose of sodium phosphate was as effective and tolerable as the conventional sodium phosphate regimen and is a satisfactory option.

Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective Randomized Trial of Oral Sodium Phosphate Solution vs Single Sodium Phosphate Enema

Study Objective To compare the effect of mechanical bowel preparation using oral sodium phosphate (NaP) solution vs single NaP enema on the quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures. Design Single-blind randomized controlled trial (Canadian Task Force classification I). Setting Academic teaching hospital. Patients Women undergoing gynecologic laparoscopic surgery. Interventions Administration of either oral NaP solution or single NaP enema for preoperative bowel preparation. Measurements and Main Results One hundred fifty-six women were enrolled, and 145 were randomized to receive either oral NaP solution (n = 72) or NaP enema (n = 73). Sixty-eight women in the oral solution group and 65 in the enema group completed the study. Assessment of the quality of the surgical field and bowel characteristics was performed using a surgeon questionnaire using Likert and visual analog scales. No significant differences were observed between the 2 groups in evaluation of the surgical field, bowel handling, degree of bowel preparation, or surgical difficulty. Surgical field quality was graded as excellent or good in 85% of women in the oral solution group and 91% of women in the enema group (p = .43). When surgeons were asked to guess the type of preparation used, they were correct only 52% of the time (κ = 0.04). Assessment of patient quality of life in the preoperative period was performed using a self-administered questionnaire using a visual analog scale. Severity of abdominal bloating and swelling, weakness, thirst, dizziness, nausea, fecal incontinence, and overall discomfort were significantly greater in the oral solution group. Women in the oral solution group also rated the preparation as significantly more difficult to administer, and were significantly less willing to try the same preparation in the future. Conclusion Quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures is similar after mechanical bowel preparation using either oral NaP solution and NaP enema. Adverse effects are more severe with oral NaP solution compared with NaP enema administration.

Incidence and Outcome of Acute Phosphate Nephropathy in Iceland

BackgroundOral sodium phosphate solutions (OSPS) are widely used for bowel cleansing prior to colonoscopy and other procedures. Cases of renal failure due to acute phosphate nephropathy following OSPS ingestion have been documented in recent years, questioning the safety of OSPS. However, the magnitude of the problem remains unknown.Methodology/Principal FindingsWe conducted a population based, retrospective analysis of medical records and biopsies of all cases of acute phosphate nephropathy that were diagnosed in our country in the period from January 2005 to October 2008. Utilizing the complete official sales figures of OSPS, we calculated the incidence of acute phosphate nephropathy in our country. Fifteen cases of acute phosphate nephropathy were diagnosed per 17,651 sold doses of OSPS (0.085%). Nine (60%) were women and mean age 69 years (range 56–75 years). Thirteen patients had a history of hypertension (87%) all of whom were treated with either ACE-I or ARB and/or diuretics. One patient had underlying DM type I and an active colitis and one patient had no risk factor for the development of acute phosphate nephropathy. Average baseline creatinine was 81.7 µmol/L and 180.1 at the discovery of acute renal failure, mean 4.2 months after OSPS ingestion. No patient had a full recovery of renal function, and at the end of follow-up, 26.6 months after the OSPS ingestion, the average creatinine was 184.2 µmol/L. The average eGFR declined from 73.5 ml/min/1.73 m2 at baseline to 37.3 ml/min/1.73 m2 at the end of follow-up. One patient reached end-stage renal disease and one patient died with progressive renal failure.Conclusion/SignificanceAcute phosphate nephropathy developed in almost one out of thousand sold doses of OSPS. The consequences for kidney function were detrimental. This information can be used in other populations to estimate the impact of OSPS. Our data suggest that acute phosphate nephropathy may be greatly underreported worldwide.

Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective Randomized Trial of Oral Sodium Phosphate Solution Versus Single Sodium Phosphate Enema

Study Objective: To compare the effect of mechanical bowel preparation (MBP) with oral sodium phosphate (NaP) solution versus single sodium phosphate (NaP) enema on the quality of the surgical field among patients undergoing advanced gynecologic laparoscopic procedures.

The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients

Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before colonoscopy. Our aim was to compare the safety, tolerability and efficiency of oral sodium phosphate solution used in colonoscopy preparation in patients over 70 years of age. This study was carried out in Ankara University School of Medicine Cebeci Hospital Endoscopy Center between August 2008 and March 2009. The extent of colon cleanliness was scored in the colonoscopy procedure. The data from the two groups were compared. In our study, 55 patients were divided into two groups according to their age, as over 70 years (n: 25) and under 70 years (n: 30). The average age of the group under 70 years was 49.4±9.8 and of the group over 70 years was 71.4±1.2 (p=0.04). Among the patients included in this study, 59.1% were female (n: 28) and 50.9% were male (n: 27). In the over 70 years group, the intestinal cleanliness was poor-fair in 2 patients, acceptable in 7 patients and excellent in 16 patients. In the below 70 years group, the intestinal cleanliness was poor in 2 patients, acceptable in 9 patients, good in 13 patients, and excellent in 6 patients. In the statistical evaluation, it was determined that there was no statistical difference between the over- and below 70 years of age groups regarding good-excellent intestinal cleanliness and poor-medium intestinal cleanliness (p=0.109). There was no statistical difference between the groups with regard to the adverse effects. The sodium, potassium and creatinine levels were assessed on the procedure day in 5 patients with clinical side effects (abdominal pain, nausea, vomiting, dizziness, hypotension) in the elderly group. No electrolyte imbalance or renal function impairment was observed in these patients. In the group of patients over 70 years old, a special patient group without comorbid diseases, oral sodium phosphate solution used for colon preparation was effective and well-tolerated with a low adverse effect rate. In spite of this safe profile, since serum creatinine levels and electrolyte imbalance were assessed in only a limited number of patients, the relationship reported in the literature between oral sodium phosphate and electrolyte imbalance and renal function impairment should be kept in mind.

Sudden Hypotensive Syncope and Significant Iatrogenic Maxillofacial Trauma following Administration of Oral Sodium Phosphate Purgative Solution

Oral sodium phosphate (NaP) solution is used globally as a bowel preparation for colonoscopy, surgery and medical-imaging (Balaban 2008). We present a case of a patient who suffered sudden hypotensive syncope and iatrogenic mandibular fractures within an hour of ingesting a NaP solution. We discuss the uses of these medicines and highlight the need to warn patients of possible adverse side effects to avoid patient harm and subsequent litigation.

T1231 Comparison of Colon Cleansing Quality Between Oral Sodium Phosphate Tablets and Oral Sodium Phosphate Solution Prior to CT Colonography

Background: Computed tomography colonography (CTC) has been recommended as a CRC screening test for average risk individuals. Like colonoscopy, the diagnostic accuracy of CTC depends upon adequate bowel preparation. Sodium phosphate tablets (SPT) have been shown to be better tolerated and to provide similar quality of cleansing when compared to sodium phosphate liquid (SPL) preparations for colonoscopy. There are no data, however, comparing the cleansing efficacy of SPT to SPL for patients undergoing CTC. We report the first data regarding the efficacy and potential renal effects of SPT compared to SPL for colon cleansing in patients undergoing CTC. Methods: In this prospective, randomized, single-blinded, investigator initiated trial, 82 patients without a history of kidney, liver or cardiac disease undergoing CTC for average risk CRC screening were randomly allocated one of three sodium phosphate regimens: SPT (Osmoprep-Salix Pharmaceuticals) in either a split-dose or night-prior regimen or SPL (Phospho Soda-C.B. Fleet Co.) in a night-prior regimen. On the day of the examination CTC radiologists rated the quality of the bowel preparation using a binary rating scale as well as a standardized residual stool scale. Patients completed a survey designed to evaluate their opinion of the preparation and their willingness to undergo the same preparation in the future. They also provided blood samples 2-6 weeks after the CTC to compare preand post-preparation serum electrolytes and renal function indices. Results: 82 people have participated (48% female, mean age 56.1 years) and primary endpoint data was evaluable in 76/82. Both the SPL and the SPT night-prior regimens appeared to provide superior preparation compared to the SPT-split dosing (76.9% excellent or good preparation vs. 25%, respectively, p=0.001). The only difference in tolerability reported was taste which was rated as more unacceptable in the SPL group compared to both SPT groups (p= 0.03). The only statistically significant change in serum electrolytes or renal function that was noted was a decrease of serum phosphate by 0.30 mg/dL (7.52%) in the SPT split-dose regimen after bowel preparation. Conclusion: Our preliminary data indicate that sodium phosphate tablets can provide adequate CTC preparation and are better tolerated than the solution form of sodium phosphate. Dosing the evening before appears to provide a better colon preparation. No patients were noted to have clinically significant changes in renal function or electrolyte values as a result of sodium phosphate preparation.