A life threatening complication after ingestion of sodium phosphate bowel preparation

Colonoscopy is a common procedure in modern health care. A prerequisite for good quality colonoscopy is adequate bowel preparation. Various methods are available, which are also used for diagnostic radiological and surgical procedures. One such agent, the oral sodium phosphate solution (Fleet Phosphosoda, C B Fleet, Lynchburg), has become increasingly popular as an alternative to gut lavage preparations since a report of its use in colonic cleansing in 1990.1 This acceptance is largely due to the smaller volume required for ingestion, with a recommended dose of 45 ml of sodium phosphate diluted with water, given at two intervals 12 hours apart (http://www.phosphosoda.com/). Numerous studies have documented its efficacy and higher patient preference and compliance.2 Furthermore, it is cheaper than other forms of bowel preparation agents.

In a recent study of colonoscopy practice in the United Kingdom, a single policy on bowel preparation was used in 82% of the gastroenterology centres, and sodium phosphate was the preferred agent in 15% of these units.3 However, once incorporated as the standard lavage regimen in units' protocols, the blanket use of sodium phosphate may result in a greater chance of serious complications because pharmaceutical warnings may not be rigidly observed. We present the case of a life threatening complication after ingestion of sodium phosphate before colonoscopy.