Sodium Phosphate Oral Solution

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

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. 

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. 

OSPS oral sodium phosphate solution RA rheumatoid arthritis... 

Comparative studies Sodium phosphate versus polyethylene glycol In a randomized, open study of renal failure after administration of oral sodium phosphate solutions or solutions containing polyethylene glycol for bowel cleansing before colonic endoscopy, 93 patients with normal renal function were allocated to oral sodium phosphate (two 45-ml doses of Fleets Phos-phoSoda separated by 12 hours) or polyethylene glycol (4 liters of Colyte) combined with adequate hydration [85 ]. Renal function was assessed 1 week before, immediately before, and 1 week after colonoscopy. No subject had acute renal failure after either formulation. However, oral sodium phosphate was associated with significant rises in serum phosphate and... 

A 57-year-old woman was given two doses of oral sodium phosphate solution over two consecutive nights before colonoscopy, after completion of which she complained of numbness and tingling in her lips, hands, and feet [87 ]. She had hypokalemia, and an electrocardiogram showed T-wave flattening and U waves. She was found to have primary hyperaldosteronism and underwent adreiisdectomy 6 months later. 

Berker D, Isik S, Aydin Y, Helvaci N, Tutuncu YA, Helvaci K, Delibasi T, Guler S. Severe hyperphosphatemia and symptomatic hypocalcemia after bowel cleansing with oral sodium phosphate solution in a patient with postoperative hypoparathyroidism. Cent Eur J Med 2010 5 65-8. 

Nam SY, Choi IJ, Park KW, Ryu KH, Kim BC, Sohn DK, Nam BH, Kim CG. Risk of hemorrhagic gastropathy associated with colonoscopy bowel preparation using oral sodium phosphate solution. Endoscopy 2010 42 109-13. 

Malik P, Balaban DH, Thompson WO, Galt DJ. Randomized study comparing two regimens of oral sodium phosphates solution versus low-dose polyethylene glycol and bisacodyl. Dig Dis Sci 2009 54 833-41. 

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. 

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. 

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. 

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. 

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. 

A 65-year-old woman took an oral sodium phosphate bowel cleansing solution, two doses of 45 ml, each containing sodium 5 g and phosphate 17.8 g, one on the evening before and one on the morning of colonoscopy [88 ]. She collapsed 30 minutes after the first dose, with transient loss of consciousness, fell, and fractured her jaw. She had mild hypernatremia and hyperphosphatemia and was resuscitated with intravenous fluids. Her mineral balance normalized within 10 hours. 

Williams JV, Colbert SD, Revington PJ. Sudden hypotensive syncope and significant iatrogenic maxillofacial trauma following administration of oral sodium phosphate purgative solution. J Perioper Pract 2010 20 181-2. 

Observational studies The use of oral sodium phosphate and polyethylene glycol solutions as bowel cleansing preparation for radiological examination of the colon has been evaluated in an observational survey in 592 adults [79 ]. Sodium phosphate was rated superior to polyethylene glycol by both patients and physicians. There were similar patterns of adverse reactions, in particular nausea (26% and 24% respectively) and cramps (20% and 27%). Abdominal bloating was more frequent with polyethylene glycol (35% versus 17%), while dry mouth occurred more frequently with sodium phosphate (16% versus 8%). 

Solutions are used topieally as well as internally. Examples of eompounded liquids include topicals (wart solutions), oral syrups and elixirs, nasal solutions, otic solutions, iontophoretic solutions (dexamethasone sodium phosphate), and many others (Table 5). 

Prednisolone Sodium Phosphate Pediapred oral solution... 

PEDIAPRED (prednisolone sodium phosphate) oral solution is a dye-free, colorless to light-straw-colored, raspberry-flavored solution. Each 5 mL (teaspoonful) of PEDI-... 

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