Korean J Crit Care Med.  2015 Feb;30(1):56-60. 10.4266/kjccm.2015.30.1.56.

Polyethylene Glycol (PEG-3350, Colyte) Poisoning due to Intra-Peritoneal Leakage in an Elderly Patient

• Chung JH
• Kim SC
• Kim JG

• KMID: 2227704
• DOI: http://doi.org/10.4266/kjccm.2015.30.1.56

Abstract

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.

Keyword

leak; poisoning; polyethylene glycols

MeSH Terms

Absorption
Acid-Base Equilibrium
Acidosis
Aged*
Colonoscopy
Humans
Hypernatremia
Metabolism
Molecular Weight
Peritoneal Cavity
Poisoning*
Polyethylene Glycols*
Renal Replacement Therapy
Therapeutic Irrigation
Polyethylene Glycols

Figure

• 

  Fig. 1. Chest X-ray (a) shows hazy infiltration in both lower lobe and abdominal computeco tomography (b, c, d) shows a large amount of ascites, a very small amount of extraluminal air (arrow) and pleural effusion on both sides. RAPS: right anterior posterior supine.

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  Fig. 2. Graphs show the serial changes of serum sodium and osmolality (a), the blood urea nitrogen and creatinine (b), the albumin-corrected anion gap and lactic acid (c), and aspartate aminotransferase and alanine aminotransferase (d) over time after the infusion of PEG-3350. Arrows show the continuous renal replacement therapy starting points. Na+ : sodium; BUN: blood urea nitrogen; Cr: creatinine: AGc: albumin-corrected anion gap: AST: aspartate aminotransferase: ALT: alanine aminotransferase: CRRT: continuous renal replacement therapy; PEG: polyethylene glycol.

Reference

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