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News

Sodium picosulfate vs polyethylene glycol bowel preparations lead to more hyponatremia

A study in the latest issue of the American Journal of Gastroenterology investigates hyponatremia and sodium picosulfate bowel preparations in older adults.

News image

Bowel preparations are commonly prescribed drugs.

Case reports and our clinical experience suggest that sodium picosulfate bowel preparations can precipitate severe hyponatremia in some older adults.

At present, this risk is poorly quantified.

Dr Matthew Weir and colleagues from Canada investigated the association between sodium picosulfate use, and the risk of hyponatremia in older adults.

The research team conducted a population-based retrospective cohort study using 6 linked administrative databases in Ontario, Canada.

All Ontario residents over the age of 65 years who filled an outpatient bowel preparation prescription before colonoscopy were eligible.

The researchers enrolled new users of either sodium picosulfate or polyethylene glycol.

Sodium picosulfate was associated with a higher risk of hospitalization with hyponatremia
American Journal of Gastroenterology

The team's primary outcome was hospitalization with hyponatremia within 30 days of the bowel preparation assessed by database codes.

The secondary outcomes were hospitalization with urgent head computed tomography (CT), and all-cause mortality.

The baseline characteristics of the 2 groups, including patient demographics, comorbid conditions, and concomitant medications, were nearly identical.

Compared with polyethylene glycol, the team noted that sodium picosulfate was associated with a higher risk of hospitalization with hyponatremia, but not hospitalization with urgent CT head or mortality.

Dr Weir's team comments, "Sodium picosulfate bowel preparations lead to more hyponatremia than polyethylene glycol."

"There was no evidence of increased risk of acute neurologic symptoms or mortality."

"The absolute increase in risk of hospitalization with hyponatremia remains low but may be avoidable through appropriate fluid intake or preferential use of polyethylene glycol in some older adults."

Am J Gastroenterol 2014; 109:686–694
21 May 2014

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