Oral sodium phosphate

Oral sodium picosulfate and oral sodium phosphate have been compared for bowel preparation before elective colorectal surgery and colonoscopy in randomized studies in 256 patients (32). Oral sodium phosphate was superior to sodium picosulfate on surgical assessment of bowel preparation, fecal residue in the resected specimen, and endoscopic score. However, there was no significant difference with regard to abdominal pain, nausea, vomiting, embarrassment, fear, and fatigue between the two groups. 

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. 

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. 

Yoshioka K, Connolly AB, Ogunbiyi OA, Hasegawa H, Morton DG, Keighley MR. Randomized trial of oral sodium phosphate compared with oral sodium picosulphate (Picolax) for elective colorectal surgery and colonoscopy. Dig Surg 2000 17(l) 66-70. 

Reddy DN, Rao GV, Sriram PV. Efficacy and safety of oral sodium phosphate versus polyethylene glycol solution for bowel preparation for colonoscopy. Indian J Gastroenterol 2002 21(6) 219-21. 

Oral sodium phosphate bowel purgatives and acute phosphate nephropathy... 

Oral sodium phosphate solution a common purgative used for colonoscopy preparation ... 

Reports of acute kidney injury following the use of oral sodium phosphate bowel purgatives ... 

There have been multiple reports of acute kidney injury following the use of oral sodium phosphate solution [13,19-33]. Many of these reports are the subject of a recent review [19] and are best divided into 2 categories. In the first group of cases, the clinical course was dominated by immediate and severe electrolyte disorders including hyperphosphatemia, and renal biopsy was not performed [13, 20-28]. In the second group of patients, the clinical course was less acute and the connection between the use of OSPS and renal failure was confirmed by renal biopsy [19, 29-33]. 

Key M male F female DM diabetes mellltus HTN hypertension CAD coronary artery disease COPD chronic obstructive pulmonary disease CHF congestive heart failure ESRD end stage renal disease OSPS oral sodium phosphate solution PEG polyethylene glycol AKI acute kidney Injury na not available HD hemodialysis. 

VannerSJ, MacDonald PH, Paterson WG, Prentice RS, Da Cost LR, Beck iT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. Am J Gastroenterol 1990 85 422-7. 

Chan A, Depew W, Vanner S. Use of oral sodium phosphate colonic lavage solution by Canadian colonoscopists pitfalls and complications. Can J Gastroenterol 1997 11 334-8. 

Mishra R, Kaufman D, Mattern J 3 , Dutta SK. Severe hyperphosphatemia and hypocalcemia caused by bowel preparation for colonoscopy using oral sodium phosphate in end-stage renal disease. Endoscopy 2005 37 1259-60. 

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. 

Ahmed M, Raval P, Buganza G. Oral sodium phosphate catharsis and acute renal failure. Am J Gastroenterol 1996 6 1261-2. 

Ma RC, ChowCC, Yeung VT, So WY, Kong AP,Tong PC,Cockram CS, Chan JC. Acute renal failure following oral sodium phosphate bowel preparation in diabetes. Diabetes Care 2007 30 182-3. 

Desmeules S. Gergeron MJ, Isenring P Acute phosphate nephropathy and renal failure. N Engl J Med 2003 349 1006-7. Markowitz GS, Stokes MB, Radhakrishnan J, D Agati VD. Acute phosphate nephropathy following oral sodium phosphate bowel purgative An underrecognized cause of chronic renal failure. J Am Soc Nephrol 2005 16 3389-3396. 

Beyea A, Block C, Schned A. Acute phosphate nephropathy following oral sodium phosphate solution to cleanse the bowel for colonoscopy. Am J Kidn Dis 2007 50 151-4,2007. 

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. 

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. 

Abaskharoun R, DepewW, Vanner S. Changes in renal function following administration of oral sodium phosphate or polyethylene glycol cleansing before colonoscopy. Can J Gastroenterol. 2007 21 227-231. 

H urst FP, Bohen EM, Osgard EM, Oliver DK, Das NP, Gao SW, Abbott KC. Acute kidney injury associated with oral sodium phosphate purgative use An observational retrospective cohort study. J Am Soc Nephrol. 2007 18 3192-8. 

Hookey LC, DepewWT, Vanner SJ. A Prospective Randomized Low-Dose Oral Sodium Phosphate Plus Stimulant Laxatives with Large Volume Polyethylene Glycol Solution for Colon Cleansing. Am J Gastroenterol 2004 99 2217-2222. 

Rostom A, JolicoeurE, Dube C, Gregoire S, Patel D, Saloojee N, Lowe C. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethyleneglycol-based lavage solution in the preparation of patients for colonoscopy. Gastrointest Endosc 2006 64 544-552. 

OSPS oral sodium phosphate solution RA rheumatoid arthritis... 

Oral sodium phosphate lowers plasma Ca concentrations and may offer short-term calcemic control of some patients with primary hyperparathyroidism who are awaiting surgery. However, the risk of precipitating calcium phosphate salts in soft tissues throughout the body is of concern. In light of satisfactory responses to other agents, administration of intravenous sodium phosphate is not recommended as a treatment for hypercalcemia. 

Magnesium- and phosphate-containing preparations are tolerated reasonably well by most patients. However, they must be used with caution or avoided in patients with renal insufficiency, cardiac disease, or preexisting electrolyte abnormalities, and in patients on diuretic therapy. Patients taking >45 mL of oral sodium phosphate as a prescribed bowel preparation may experience electrolyte shifts that pose a risk for the development of symptomatic dehydration, renal failure, metabolic acidosis, hypocalcemic tetany, and even death in medically vulnerable populations. 

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... 

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