Korean J Med.  2016 Oct;91(2):206-210. 10.3904/kjm.2016.91.2.206.

Severe Hyponatremia with Mental Change after Ingestion of Picosulfate Sodium/Magnesium Citrate for Bowel Preparation

• Kim W
• Park SY
• Kim MJ
• Koo HM

• KMID: 2357440
• DOI: http://doi.org/10.3904/kjm.2016.91.2.206

Abstract

Picosulfate sodium/Magnesium citrate (PS/MC) is a common bowel cleansing agent for colonoscopy. It is equally effective and better tolerated by patients with regard to taste and volume than polyethylene glycol. However, because of its osmotically active characteristics, PS/MC can cause plasma volume depletion and electrolyte disturbances, such as hyponatremia. Here, we report a case of severe hyponatremia combined with loss of consciousness in a 59-year-old woman following ingestion of PS/MC as bowel preparation for a screening colonoscopy. Upon arrival, serum sodium level was 109 mEq/L and urine osmolality and sodium levels were 393 mOms/Kg and 99 mmol/L, respectively. She was euvolemic and showed normal kidney, thyroid, and adrenal function. Based on these findings, inappropriate anti-diuretic hormone syndrome (SIADH) was diagnosed. She was treated with 3% hypertonic saline and completely recovered without any neurologic sequelae. This case shows that SIADH can be caused by PS/MC (not accompanied by dehydration), even in patients without any underlying renal, heart, or liver diseases.

Keyword

Picosulfate sodium/Magnesium citrate; Hyponatremia; Inappropriate ADH syndrome

MeSH Terms

Citric Acid*
Colonoscopy
Detergents
Eating*
Female
Heart
Humans
Hyponatremia*
Inappropriate ADH Syndrome
Kidney
Liver Diseases
Mass Screening
Middle Aged
Osmolar Concentration
Plasma Volume
Polyethylene Glycols
Sodium
Thyroid Gland
Unconsciousness
Citric Acid
Detergents
Polyethylene Glycols
Sodium