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Hyponatremic Coma after Bowel Preparation.

João Costelha1, Rita Dias2, Carla Teixeira3

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European Journal of Case Reports in Internal Medicine
|October 5, 2019
PubMed
Summary
This summary is machine-generated.

Symptomatic hyponatremic coma is a rare but serious complication of colonoscopy bowel preparation. Patients at risk should be monitored, and macrogol-based solutions may be preferred to prevent electrolyte imbalances.

Keywords:
Hyponatremiabowel preparationcoma

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Area of Science:

  • Gastroenterology
  • Nephrology
  • Internal Medicine

Background:

  • Colonoscopy is a vital diagnostic and therapeutic tool.
  • Bowel preparations can lead to electrolyte imbalances, influenced by solution type, patient age, and comorbidities.
  • Symptomatic hyponatremia, including coma, is a rare but serious complication of oral bowel preparation for colonoscopy.

Purpose of the Study:

  • To report a case of hyponatremic coma following bowel preparation for colonoscopy.
  • To highlight the risks and management of hyponatremia associated with bowel cleansing agents.

Main Methods:

  • Case report of a 48-year-old male who developed hyponatremic coma after using sodium picosulfate/magnesium oxide/citric acid for bowel preparation.
  • Exclusion of other causes of coma in the intensive care unit.
  • Treatment with intravenous hypertonic saline for rapid symptom resolution.

Main Results:

  • The patient experienced symptomatic hyponatremia (coma) after bowel preparation.
  • Symptoms rapidly resolved following correction of sodium levels with hypertonic saline.
  • Hyponatremic coma is an uncommon but serious complication.

Conclusions:

  • Patients at increased risk (e.g., >65 years, CKD, heart failure, electrolyte issues, certain medications) require close monitoring during bowel cleansing.
  • Macrogol-based solutions are recommended for bowel preparation in at-risk individuals.
  • Maintain a low threshold for investigating and treating electrolyte disturbances during bowel preparation.