PDF herunterladen
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(08): E1198-E1204
DOI: 10.1055/a-1478-3361
Original article

Safety of low-volume PEG-asc bowel cleansing preparation for colonoscopy: identifying patients at risk for hypokalemia in a prospective cohort study

Ankie Reumkens
1   Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard-Heerlen, the Netherlands
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
3   NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
,
Christine Minke Bakker
1   Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard-Heerlen, the Netherlands
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
,
Sebastiaan J.W. van Kraaij
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
,
Bjorn Winkens
4   Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, the Netherlands
5   CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands
,
Maarten T. Raijmakers
6   Department of Clinical Chemistry and Haematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
,
Annick B. van Nunen
1   Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard-Heerlen, the Netherlands
,
Cees Th.B.M. van Deursen
1   Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard-Heerlen, the Netherlands
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
,
Ad A.M. Masclee
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
3   NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Einführung zu diesem Artikel:

The lower the volume of a cleansing product the higher its osmolarity and thus the risk of determining electrolyte imbalances in predisposed patientsEndosc Int Open 2021; 09(08): E1205-E1206
DOI: 10.1055/a-1487-5876

Abstract

Background and study aims The aim of bowel cleansing preparation should be high-quality results and conformance with safety standards. Previously, we reported that hypokalemia occurred in 23.6 % of patients after bowel preparation in a high-risk population on diuretics or hospitalized and referred for colonoscopy. Here we report on a prospective study in a non-selected colonoscopy cohort to identify patients at risk of developing hypokalemia before and after bowel cleansing with low-volume polyethylene glycol with ascorbic acid (PEG-asc).

Patients and methods From January 1 to July 31, 2016, we included all patients undergoing colonoscopy in our institution. Prevalences of hypokalemia before and after PEG-asc bowel cleansing for colonoscopy were calculated and risk factors for developing hypokalemia after PEG-asc bowel cleansing were identified.

Results In total, 2011 patients were included in the analysis. Of these, 0.8 % had hypokalemia before bowel cleansing with PEG-asc. After bowel preparation, 5.4 % developed hypokalemia. Of the patients, 281 were considered to have “high cardiac risk.” The combination of “high cardiac risk” and hypokalemia was present in 1 % of the initial colonoscopy population. Female sex, colorectal cancer diagnosis, and thiazide use were found to be significant predictors for hypokalemia after use of PEG-asc. No arrhythmias or serious adverse events due to hypokalemia occurred.

Conclusions Physicians referring patients for colonoscopy should be aware that “high cardiac risk” patients and those on thiazide diuretics undergoing bowel cleansing for colonoscopy are a risk of developing post-cleansing hypokalemia but it remains to be determined whether their risk of developing life-threatening arrhythmias is truly increased.



Publikationsverlauf

Eingereicht: 15. Dezember 2020

Angenommen: 01. März 2021

Artikel online veröffentlicht:
16. Juli 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedGoogle Scholar
  • 2 Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc 2010; 71: 366-381.e362
    CrossrefPubMedGoogle Scholar
  • 3 Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy - a meta-analysis. Colorectal Dis 2006; 8: 247-258
    CrossrefPubMedGoogle Scholar
  • 4 Fordtran JS, Hofmann AF. Seventy years of polyethylene glycols in gastroenterology: the journey of PEG 4000 and 3350 from nonabsorbable marker to colonoscopy preparation to osmotic laxative. Gastroenterology 2017; 152: 675-680
    CrossrefPubMedGoogle Scholar
  • 5 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology 2014; 147: 903-924
    CrossrefPubMedGoogle Scholar
  • 6 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775-794
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Saltzman JR, Cash BD, Pasha SF. et al. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81: 781-794
    CrossrefPubMedGoogle Scholar
  • 8 Fujita I, Akagi Y, Hirano J. et al. Distinct mechanisms of transport of ascorbic acid and dehydroascorbic acid in intestinal epithelial cells (IEC-6). Res Commun Mol Pathol Pharmacol 2000; 107: 219-231
    PubMedGoogle Scholar
  • 9 Reumkens A, Masclee AAM, Bakker CM. Postcolonoscopy mortality: Bowel preparation to blame?. Gastrointest Endosc 2017; 86: 744-745
    CrossrefPubMedGoogle Scholar
  • 10 Reumkens A, Masclee AA, Winkens B. et al. Prevalence of hypokalemia before and after bowel preparation for colonoscopy in high-risk patients. Gastrointest Endosc 2017; 86: 673-679
    CrossrefPubMedGoogle Scholar
  • 11 Ho JM, Juurlink DN, Cavalcanti RB. Hypokalemia following polyethylene glycol-based bowel preparation for colonoscopy in older hospitalized patients with significant comorbidities. Ann Pharmacother 2010; 44: 466-470
    CrossrefPubMedGoogle Scholar
  • 12 Hoorn EJ, Tuut MK, Hoorntje SJ. et al. Dutch guideline for the management of electrolyte disorders -- 2012 revision. Netherlands J Med 2013; 71: 153-165
    PubMedGoogle Scholar
  • 13 Cohn JN, Kowey PR, Whelton PK. et al. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Int Med 2000; 160: 2429-2436
    CrossrefPubMedGoogle Scholar
  • 14 Ayuk J, Gittoes NJ. How should hypomagnesaemia be investigated and treated?. Clin Endocrinol 2011; 75: 743-746
    CrossrefPubMedGoogle Scholar
  • 15 Nilsson E, Gasparini A, Arnlov J. et al. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J Cardiol 2017; 245: 277-284
    CrossrefPubMedGoogle Scholar
  • 16 Kleinfeld M, Borra S, Gavani S. et al. Hypokalemia: are elderly females more vulnerable?. J Natl Med Assoc 1993; 85: 861-864
    PubMedGoogle Scholar
  • 17 Gennari FJ. Hypokalemia. N Engl J Med 1998; 339: 451-458
    CrossrefPubMedGoogle Scholar
  • 18 Ellison DH, Loffing J. Thiazide effects and adverse effects: insights from molecular genetics. Hypertension 2009; 54: 196-202
    CrossrefPubMedGoogle Scholar
  • 19 Liamis G, Filippatos TD, Elisaf MS. Electrolyte disorders associated with the use of anticancer drugs. Euro J Pharmacol 2016; 777: 78-87
    CrossrefPubMedGoogle Scholar
  • 20 Pepin J, Shields C. Advances in diagnosis and management of hypokalemic and hyperkalemic emergencies. Emerg Med Pract 2012; 14: 1-17 ; quiz 17–18
    PubMedGoogle Scholar
  • 21 Udensi UK, Tchounwou PB. Potassium homeostasis, oxidative stress, and human disease. Int J Clin Exp Physiol 2017; 4: 111-122
    CrossrefPubMedGoogle Scholar
  • 22 Clayton JA, Rodgers S, Blakey J. et al. Thiazide diuretic prescription and electrolyte abnormalities in primary care. Br J Clin Pharmacol 2006; 61: 87-95
    CrossrefPubMedGoogle Scholar
  • 23 Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Int Med 1992; 152: 40-45
    CrossrefPubMedGoogle Scholar
  • 24 Freedberg DE, Kim LS, Yang YX. The Risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology 2017; 152: 706-715
    CrossrefPubMedGoogle Scholar