Year 2013 / Volume 105 / Number 3
Letter to the Editor
Severe rhabdomyolysis and hyponatremia induced by picosulfate and bisacodyl during the preparation of colonoscopy

pp. 180-182

Antonio Más, Juan José Chillarón, Erika Esteve, Irene Navalpotro y August Supervía

Abstract
A 57-year-old woman was admitted for a generalized tonic- clonic seizure. She had clinical history of hypothyroidism, migraine and hypercholesterolemia.
The patient was scheduled a colonoscopy for investigation of rectal tenesmus. Three days before she had initiated a bowel preparation based on a liquid diet. The day of admission, the patient had an elevated water intake and she had taken two sachets of CitraFleet® and two tablets of bisacodyl.

On examination, the patient presented temporal disorientation, indifferent right cutaneous plantar reflex and lack of neck stiffness or other alterations. Biochemical results are reported in Table I. The main findings were serum sodium of 120 mEq/l and an initial creatine phosphokinase (CK) levels of 429 IU/l that reached a maximum level of 30778 IU/l. Brain CT showed a small chronic infarction, and no other relevant findings.

Due to the presence of neurological symptoms, a 3 % saline infusion was initiated at a rate of 1.5 ml/kg/h. After two hours of treatment, sodium levels increased and neurological symptoms resolved and treatment was switched to a 0.9 % saline infu- sion. Regarding CK levels, they increased during the first 72 hours in spite of serum therapy and they gradually declined on the following days. Renal function was preserved throught the process.
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Antonio Más, Juan José Chillarón, Erika Esteve, Irene Navalpotro y August Supervía. Severe rhabdomyolysis and hyponatremia induced by picosulfate and bisacodyl during the preparation of colonoscopy. 180-182


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