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  • Review Article
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The safety of osmotically acting cathartics in colonic cleansing

Abstract

Efficient cleansing of the colon before a colonoscopy or a radiological examination is essential. The osmotically acting cathartics (those given the Anatomical Therapeutic Chemical code A06AD) currently used for this purpose comprise products based on three main substances: sodium phosphate, combinations of polyethylene glycol and electrolyte lavage solutions (PEG–ELS), and magnesium citrate. All these preparations give adequate cleansing results and have similar profiles in terms of the frequency and type of mild to moderate adverse effects. However, serious adverse events, such as severe hyperphosphatemia and irreversible kidney damage owing to acute phosphate nephropathy, have been reported after use of sodium-phosphate-based products. The aim of this Review is to provide an update on the potential safety issues related to the use of osmotically acting cathartics, especially disturbances of renal function and water and electrolyte balance. The available evidence indicates that PEG–ELS-based products are the safest option. Magnesium-citrate-based, hypertonic products should be administered with caution to elderly individuals and patients who are prone to develop disturbances in water and electrolyte balance. Sodium-phosphate-based products can occasionally cause irreversible kidney damage and should not be routinely used in bowel-cleansing procedures.

Key Points

  • Bowel-cleansing procedures can have dehydrating effects; ensuring sufficient hydration of patients is, therefore, essential

  • In patients with relevant comorbidities or those on medications that influence water and electrolyte balance, iso-osmotic preparations are safer options than hyperosmotic products

  • Monitoring of serum electrolytes is recommended in patients treated with osmotically acting cathartics (especially individuals with relevant comorbidities and those on medications that influence the water and electrolyte balance)

  • Routine use of sodium-phosphate-based cathartics is not recommended because of their potential serious adverse effects on kidney function

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Figure 1: Adverse events associated with use of the three major types of osmotically acting cathartics.

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Correspondence to Ole H. Nielsen.

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Nyberg, C., Hendel, J. & Nielsen, O. The safety of osmotically acting cathartics in colonic cleansing. Nat Rev Gastroenterol Hepatol 7, 557–564 (2010). https://doi.org/10.1038/nrgastro.2010.136

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