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Prevalence of hypokalemia before and after bowel preparation for colonoscopy in high-risk patients

  • Ankie Reumkens
    Correspondence
    Reprint requests: Ankie Reumkens, MD, Department of Gastroenterology and Hepatology, Zuyderland Medical Center Heerlen, Post box 5500, 6130 MB, Sittard-Geleen, The Netherlands.
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, the Netherlands

    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands

    NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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  • Ad A. Masclee
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands

    NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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  • Bjorn Winkens
    Affiliations
    Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands

    CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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  • Cees T. van Deursen
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, the Netherlands

    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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  • Silvia Sanduleanu
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands

    GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht the Netherlands
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  • Christine M. Bakker
    Affiliations
    Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, the Netherlands
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Published:February 07, 2017DOI:https://doi.org/10.1016/j.gie.2017.01.040

      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:

      CI (confidence interval), IQR (interquartile range), OR (odds ratio)
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      Linked Article

      • Postcolonoscopy mortality: Bowel preparation to blame?
        Gastrointestinal EndoscopyVol. 86Issue 4
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          Bowel 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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