Intended for healthcare professionals

Practice Lesson of the week

A life threatening complication after ingestion of sodium phosphate bowel preparation

BMJ 2006; 333 doi: (Published 14 September 2006) Cite this as: BMJ 2006;333:589
  1. Y Mun Woo (, staff grade in nephrology1,
  2. Susan Crail, specialist registrar in nephrology2,
  3. Graham Curry, consultant physician3,
  4. Colin C Geddes, consultant nephrologist1
  1. 1 Renal Unit, Inverclyde Royal Hospital, Greenock PA16 0XN,
  2. 2Renal Unit, Western Infirmary, Glasgow,
  3. 3Medical Unit, Inverclyde Royal Hospital
  1. Correspondence to: YMWoo
  • Accepted 14 April 2006

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 ( 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.

Case report

A 64 year old man with Wegener's granulomatosis who attends for routine hospital haemodialysis presented for his routine dialysis with a 24 hour history of tetany, including locked jaw and carpopedal spasm. He also described skin paraesthesia …

View Full Text

Log in

Log in through your institution


* For online subscription