Cleansing, bowel

Wille-Jorgensen P, Guenaga KF, Castro AA, Matos D Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery A systematic review. Dis Colon Rec-tum 2003 46(8) 1013-1018. 

Fleet Prep Kit 1, 2, and 3 (Fleet), X-Prep Liquid, X-Prep Bowel Evacuant Kit-1 (Gray), Tridate Bowel Cleansing System (Lafayette)... 

Oral sodium phosphate 90 ml mixed with 300 ml of clear liquid has been compared with 2 liters of polyethylene glycol solution in a colonoscopist-blinded, randomized trial in 100 patients undergoing colonoscopy as a daycare procedure (40). Sodium phosphate was well tolerated and safe and provided bowel cleansing similar to polyethylene glycol. Five patients who received polyethylene glycol and four who received sodium phosphate reported nausea, and eight patients who received polyethylene glycol and one who received sodium phosphate complained of abdominal fullness. 

The standard regimen of sodium phosphate used for bowel cleansing before colonoscopy is 40 tablets (60 g). In a randomized, multicenter, endoscopist-blinded trial in 98 patients undergoing colonoscopy, two smaller doses of sodium phosphate, 28 tablets (42 g) and 32 tablets (48 g), were effective (quality of colon cleansing excellent or good in over 80%) and well tolerated (41). The incidences of adverse effects were similar in the two groups. 

Tonic-clonic seizures have been reported in four adults who took oral sodium phosphate as Visicol (InKline Pharmaceutical total 40 tablets) for bowel cleansing before colonoscopy (42). None of the patients had a history of seizures or electrolyte abnormahties. In all cases the seizures were associated with electroljde abnormalities, mainly hyponatremia, after administration of Visicol. 

Sodium phosphates are considered to be dangerous (1), particularly because of their effects on electrolyte balance. An oral solution of sodium phosphates (dibasic sodium phosphate + monobasic sodium phosphate) is used as a laxative for the relief of occasional constipation and is used as part of a bowel-cleansing regimen in preparing patients for surgery or colonoscopy. 

The Austrian Adverse Drug Reactions Advisory Committee received three reports of severe electroljde disturbances associated with an oral bowel-cleansing solution containing sodium phosphate solution (Fleet Phospho-Soda Buffered Saline Laxative Mixture), used as a bowel preparation for colonoscopy (5). Prescribers are advised to be aware of complications of the use of phosphate enemas, particularly in infants, elderly or debilitated patients, patients with congestive heart failure, and patients with impaired renal function. 

Cohen SM, Wexner SD, Binderow SR, Nogueras JJ, Daniel N, Ehrenpreis ED, Jensen J, Bonner GF, Ruderman WB. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994 37 689-696. 

Gonlusen G, Akgun H, Ertan A, OliveroJ,Truong L. Renal Failure and Nephrocalcinosis Associated with Oral Sodium Phosphate Bowel Cleansing. Arch Patholo Lab Med 2006 130 101-6. 

Aasebo W, Scott H, Ganss R. Kidney biopsies taken before and after sodium phosphate bowel cleansing. Nephrol DialTransplant 2006 22 920-922. 

Markowitz GS, Nasr SH, Klein P, Anderson H. Stack Jl, Alterman L, Price B, Radhakrishnan J, D Agati VD. Renal failure and acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Human Pathol 2004 35 675-684. 

Markowitz GS, Whelan, J, D Agati, VD Renal failure following bowel cleansing with a sodium phosphate purgative. Nephrol Dial Transplant 2005 20 850-851. 

Beloosesky Y, Grinblat J, Weiss A, Grosman B, Gafter U, Chagnac A Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med 2003 163 803-8. 

Oral administration of large quantities of polyethylene glycols can have a laxative effect. Therapeutically, up to 4 L of an aqueous mixture of electrolytes and high-molecular-weight polyethylene glycol is consumed by patients undergoing bowel cleansing. 

For example, we need to have regular elimination in order to be healthy and well, but we can t make up for a lack of chemical elements by means of bowel cleansing, such as enemas and colonics. I m going to discuss bowel health right at the beginning because a healthy digestive and eliminative system is essential to good health. 

Bowel cleansing/enema Discontinue diuretics Discontinue NSAIDs, nephrotoxic antibiotics Eluid resuscitation... 

Bowel evacuants are known as bowel cleansing solutions. They are used before surgery or radiological procedures to empty the bowel. They can cause bloating and nausea. Examples are magnesium salts and Picolax and polyethylene glycol. 

Prior to examination barium enema patients require bowel cleansing, achieved by oral laxatives. 

Gonlusen G, Akgun H, Brian A, Olivero J, Truong LD (2006) Renal failure and nephrocalcinosis associated with oral sodium phosphate bowel cleansing clinical patterns and renal biopsy findings. Arch Pathol Lab Med 130 101-106... 

In both cases, the liquid contrast medium should be non-absorbable and non-fermentable. Isotonic anechoic electrolyte solution containing PEG, which is used for bowel cleansing prior to colonoscopy, is now considered the contrast medium of choice. The ingestion of a variable amount of PEG (up to 1000 ml range 250-820 ml) provides an adequate distension of the intestinal loops, removes gas making sequential visualisation of the entire small bowel from the duodenum to terminal ileum easier and also allowing measurement of wall thickness and luminal diameter (Pallotta et al. 1999a,b,2000) (Table 21.1). 

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