Kosin Med J.  2012 Dec;27(2):173-176. 10.7180/kmj.2012.27.2.173.

Acute Severe Hyponatremia with Seizure Following Polyethylene Glycol-Based Bowel Preparation for Colonoscopy

• Lee MH
• Lee BH
• Oh SK
• Seo JY
• Kim HJ
• Seo BJ

• KMID: 2308527
• DOI: http://doi.org/10.7180/kmj.2012.27.2.173

Abstract

4 liters of polyethylene glycol (PEG) solution is commonly used to evacuate the colon before colonoscopy. This substance, however, is known to cause electrolyte abnormalities such as hyponatremia. Seizures caused by hyponatremia associated with bowel preparation have only rarely been reported. We report the case that a 75-year-old woman with no prior history of seizures was developed severe hyponatremia (112 mEq/L) with generalized tonic-clonic seizure and mental change after ingestion of 4L of PEG solution. Past medical history was notable for thiazide diuretics. Her symptoms are improved during intravenous administration of hypertonic saline for the correction of hyponatremia. Patients with impaired ability to excrete free water those with renal insufficiency, hypothyroidism, mineralocorticoid deficiency, liver cirrhosis, or heart failure as well as those taking drugs which including thiazide diuretics, NASIDs, and ACE inhibitors have risk of hyponatremia following bowel preparation for colonoscopy. We conclude that physicians should check patient's condition and electrolyte abnormalities before colonoscopy procedures.

Keyword

Colonoscopy; Hyponatremia; Polyethylene glycol; Seizure

MeSH Terms

Administration, Intravenous
Angiotensin-Converting Enzyme Inhibitors
Colon
Colonoscopy
Eating
Female
Heart Failure
Humans
Hyponatremia
Hypothyroidism
Liver Cirrhosis
Polyethylene
Polyethylene Glycols
Renal Insufficiency
Seizures
Sodium Chloride Symporter Inhibitors
Water
Angiotensin-Converting Enzyme Inhibitors
Polyethylene
Polyethylene Glycols
Sodium Chloride Symporter Inhibitors
Water

Reference

1. Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy - a meta-analysis. Colorectal Dis. 2006. 8:247–258.

2. Marín Gabriel JC, Rodríguez Muñoz S, de la Cruz Bértolo J, Carretero Gómez JF, Muñoz Yagüe MT, Manzano Alonso ML, et al. Electrolytic disturbances and colonoscopy: bowel lavage solutions, age and procedure. Rev Esp Enferm Dig. 2003. 95:863–875.

3. Ayus JC, Levine R, Arieff AI. Fatal dysnatraemia caused by elective colonoscopy. BMJ. 2003. 326:382–384.

4. Ok KS, Kim YS, Jang WC, Jeong TY, Huh JG, Ryu SH, et al. Hyponatremic Encephalopathy Following a Sulfate Free Polyethylene Glycol-based Bowel Preparation for Colonoscopy. Korean J Gastrointest Endosc. 2008. 37:303–307.

5. Heo C, Oh HC, Kim JW, Kim JG. Acute hyponatremic encephalopathy after Ingestion of polyethylene glycol solution before colonoscopy. Korean J Gastrointest Endosc. 2009. 39:169–171.

6. Choi KS, Lee YM, Jung SW, Kim BS, Shin JH, Baek SH, et al. Three cases of hyponatremia caused by ingestion of bowel preparation solution for colonoscopy. Korean J Nephrol. 2005. 24:295–299.

7. Nagler J, Poppers D, Turetz M. Severe hyponatremia and seizure following a polyethylene glycol-based bowel preparation for colonoscopy. J Clin Gastroenterol. 2006. 40:558–559.

8. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000. 342:1581–1589.

9. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008. 52:144–153.

10. Hampton KK, Grant PJ, Primrose J, Dean HG, Davies JA, Prentice CR. Haemostatic responses and vasopressin release during colonoscopy in man. Clin Sci (Lond). 1991. 81:257–260.

11. Cohen CD, Keuneke C, Schiemann U, Schroppel B, Siegert S, Rascher W, et al. Hyponatraemia as a complication of colonoscopy. Lancet. 2001. 357:282–283.

12. Verbalis JG. Schrier RW, Gottschalk CW, editors. The syndrome of inappropriate antidiuretic hormone secretion and other hypoosmolar disorders. Diseases of the kidney. 2001. 7th ed. Philadelphia: Lippincott Williams & Wilkins;2511–2548.