Background and Aims
Bowel preparation for colonoscopy should not cause significant shifts in systemic
electrolyte concentrations. We recently encountered 2 cases of severe postcolonoscopy
hypokalemia with fatal consequences, prompting us to conduct a study to explore the
magnitude of and risk factors for hypokalemia associated with bowel preparation. We
paid specific attention to higher-risk subgroups, in particular, diuretic users, hospitalized
patients, and patients estimated to be at high risk by the gastroenterologist.
Methods
From January 1 to December 31, 2014, we included all patients at risk for hypokalemia
(diuretic users, hospitalized patients, and patients estimated at high risk by the
gastroenterologist) who underwent colonoscopy at our institution. We measured serum
potassium levels before low-volume polyethylene glycol bowel preparation for colonoscopy.
In a subset of patients who had normal serum potassium levels before bowel cleansing,
serum potassium levels after bowel cleansing also were measured.
Results
In total, 5515 colonoscopies were performed, including 1822 procedures in diuretic
users or hospitalized patients. Of these, 77 (4.2%) patients had hypokalemia before
bowel cleansing. A logistic regression model showed that hospitalized patients were
more likely to have hypokalemia than non-hospitalized patients. 301 patients with
normal potassium levels had potassium controls after bowel cleansing, of whom 71 (23.6%)
developed hypokalemia. A logistic regression model showed that diuretic users were
more likely to develop hypokalemia than those who did not use diuretics.
Conclusions
Hypokalemia is frequently encountered after low-volume polyethylene glycol bowel cleansing
in high-risk patients. Additional large-scale studies are needed on the prevalence
of hypokalemia in unselected populations undergoing bowel cleansing and on the occurrence
of potentially very serious side effects in order to decide on screening of high-risk
groups in daily clinical practice. (Clinical trial registration number: NTR5400.)
Abbreviations:
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Article info
Publication history
Published online: February 07, 2017
Accepted:
January 31,
2017
Received:
July 11,
2016
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2017 by the American Society for Gastrointestinal Endoscopy
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- Postcolonoscopy mortality: Bowel preparation to blame?Gastrointestinal EndoscopyVol. 86Issue 4
- PreviewBowel preparation for colonoscopy should be safe, without clinically relevant shifts in serum potassium levels. It has been shown that polyethylene glycol (PEG) solutions may cause hypokalemia, but the prevalence, magnitude, and clinical consequences of hypokalemia associated with low-volume PEG bowel preparation are not known. We recently encountered 2 cases of severe postcolonoscopy hypokalemia with fatal outcome at our secondary care hospital.
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