Fatal dysnatraemia caused by elective colonoscopy: Lesson was unnecessarily alarmist

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7399.1146-b (Published 22 May 2003) Cite this as: BMJ 2003;326:1146
  1. Brian P Saunders, consultant physician (b.saunders{at}ic.ac.uk),
  2. Christopher B Williams, consultant endoscopist
  1. St Mark's Hospital, Northwick Park, Harrow, Middlesex HA1 3UJ

    EDITOR—The lesson given for Ayus et al's report of fatal dysnatraemia caused by elective colonoscopy was that plasma sodium concentration should always be checked after colonoscopy.1 We speculate that this strongly worded advice may have been added by your editorial team, in our opinion entirely without warrant and also against the carefully worded discussion and conclusions of the authors.

    The patients described in the report all had reasons for potential electrolyte imbalance (one was taking diuretics, two had end stage renal failure). The valuable message of the communication was that patients with abnormal electrolyte handling, including some elderly patients, who have high volume balanced electrolyte preparation require monitoring of their plasma electrolyte status. Sick or frail patients and those with complications require extra care. Any fatality or serious consequence of medical manipulation deserves careful consideration by the profession.

    However, many millions of colonoscopies have been performed around the world without any other such report of fatal electrolyte imbalance. Similar bowel preparation has been safely used for many years for barium studies, and more recently for “virtual colography” and other procedures. The benefits of colonoscopy are huge, combining unusually accurate diagnosis, the potential for immediate polypectomy, and so the chance of reducing the currently appalling incidence of colorectal cancer.

    That such a rare event should be accepted for and given prominence in the BMJ with an added touch of tabloid sensationalism is surprising. Sick patients require appropriate monitoring, and well people and their medical attendants should expect that colonoscopy (and the bowel preparation before it) should be an atraumatic and very safe experience. We and others are striving to raise standards of colonoscopy performance, training, and availability. For the BMJ to raise unwarranted fears about routine arrangements for elective colonoscopy (emergency colonoscopies are vanishingly rare) is not in the general interest.


    • Competing interests None declared.


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