Fatal hyperphosphatemia from a phosphosoda bowel preparation

Area of Science:

• Gastroenterology
• Nephrology
• Clinical Toxicology

Background:

• Oral phosphosoda is a cost-effective and low-volume alternative for bowel preparation before colonoscopy.
• Despite a generally good safety profile, serious adverse events associated with oral phosphosoda have been reported.

Observation:

• A 55-year-old male patient with a history of end-stage renal disease and a prior kidney transplant developed cardiorespiratory arrest post-oral phosphosoda bowel preparation.
• The patient experienced severe hyperphosphatemia (17.8 mg/dL), acidosis, hypoxia, and acute kidney injury.

Findings:

• The patient's condition rapidly deteriorated six hours after receiving 90 mL of oral phosphosoda.
• Autopsy revealed ischemic colitis, suggesting a link between the bowel preparation and the fatal outcome.

Implications:

• Oral phosphosoda bowel preparation poses significant risks, particularly for individuals with compromised renal function or gastrointestinal motility issues.
• This case highlights the critical need for careful patient selection and risk assessment when considering oral phosphosoda for bowel preparation.