THE TIME COURSE AND EFFECT ON SERUM ELECTROLYTES OF ORAL SODIUM PHOSPHATES SOLUTION IN HEALTHY MALE AND FEMALE VOLUNTEERS
Main Article Content
Keywords
Age, oral sodium phosphates solution, electrolytes, Phospho-soda
Abstract
Background
Although oral sodium phosphates solution is used extensively for bowel preparation, the pharmacokinetic profile of 2 x 45 mL oral sodium phosphates solution has not been reported.
Objectives
The primary objective of this study was to evaluate the time course and degree of electrolyte shifts in two age groups and two gender groups following administration of oral sodium phosphates solution. Secondary objectives included evaluation of electrocardiograms, postural blood pressure, standard serum chemistry and hematology panels, and adverse experiences.
Methods
Twenty-four healthy adult volunteers were divided equally into groups based on age and gender. Each received 2 ´ 45 mL oral sodium phosphates solution at 7:00pm (hour 0) and at 7:00am (hour 12). Serum electrolytes were measured at sixteen different time points.
Results
Mean serum phosphate concentrations exceeded the upper normal limit within 1 hour following the first dose, peaking at 3 hours (6.26 mg/dL; p < 0.0001) before decreasing. Following the second dose at 12 hours, mean serum phosphate concentrations peaked at 14 hours (6.86 mg/dL; p < 0.0001), before decreasing to normal limits by hour 24. Mean serum sodium, potassium, and calcium concentrations fluctuated within the normal range. However, serum sodium concentrations peaked at 1 hour following the second dose of phosphate, showing a statistically significant (p < 0.0001) increase of 2.4% from baseline to 144.8 mmol/L. No clinically significant changes in ECG were observed. Mean reductions in supine and standing systolic blood pressure were not associated with postural change. No subject had postural decreases in systolic blood pressure of greater than 20 mmHg.
Conclusions
Administration of 2 x 45 mL oral sodium phosphates solution 12 hours apart with proper hydration caused transient serum electrolyte shifts, which were clinically insignificant and resolved within 24 hours.
References
2. Carrera AE. Effect of oral administration of Fleet Phospho-soda on serum phosphorus concentration. Am J Clin Pathol 1968;49:739-741
3. Vanner SJ, MacDonald PH, Paterson WG, et al. A randomized prospective trial comparing oral phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. Am J Gastroenterol 1990;85:422-427.
4. Aronchick CA, Lipshutz WH, Wright SH, et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000;52:346-352.
5. Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy. Dis Colon Rectum 1997;40:100-104.
6. Berkelhammer C, Ekambaram A, Silva RG. Low- volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate. Gastrointest Endosc 2002;56:89-94.
7. Bujanda L, Muñoz C, Sánchez A, et al. Tolerance to and colon cleansing with two preparations. polyethylene glycol or sodium phosphate. Gastroenterol Hepatol 2001;24:9-12.
8. Poon CM, Lee DWH, Mak SK, et al. Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial. Endoscopy 2002;34:560-563.
9. Parra-Blanco A, Nicolas D, Gimeno A-Z, et al. Timing of bowel cleansing solution administration before colonoscopy determines the quality of colonic preparation and the detection of flat polyps. Gastrointest Endosc 2003;57, AB103.
10. Canard JM. Fleet Phospho-soda: for greater acceptability of the colic preparation before colonoscopy. Randomized comparative single blind study versus polyethylene glycol. Acta Endoscopica 2001;31:703-708.
11. Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomized endoscopic-blinded trial comparing pre-colonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689-696.
12. Pou Fernández JM, Munoz SR, Felis TS. Characterization of the safety, effectiveness and use of oral sodium phosphate. Rex Esp Enferm Dig
2001;93:220-225.
13. Balaban DH, Leavell BS, Oblinger MJ, Thompson WO, Bolton ND, Pambianco DJ. Low volume bowel preparation for colonoscopy: randomized, endoscopist-blinded trial of liquid sodium phosphate versus tablet sodium phosphate. Am J Gastroenterol 2003;98:827-832.
14. Young CJ, Simpson RR, King DW, Lubowski DZ. Oral sodium phosphate solution is a superior colonoscopy preparation to polyethylene glycol with bisacodyl. Dis Colon Rectum 2000;43:1568-1571.
15. Huynh T, Vanner S, Paterson W. Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemia. Am J Gastroenterol 1995;90:104-107.
16. DiPalma JA, Buckely SE, Warner BA, Culpepper RM. Biochemical effects of oral sodium phosphate. Dig Dis Sci 1996;41:749-753.
17. Brown AR, DiPalma JA. Bowel preparation for gastrointestinal procedures. Curr Gastroenterol Rep 2004;6:395-401.
18. Gumurdulu Y, Serin E, Ozer B, Gokcel A, Boyacioglu S. Age as a predictor of hyperphosphatemia after oral phosphosoda administration for colon preparation. J Gastroenterol Hepatol 2004;19:68-72.
19. Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996;43:467-469.
20. Ma K, Ng C, Mui L, Chan K, Ng E. Severe hyperphosphatemia and hypocalcemia following sodium phosphate bowel preparation: a forgotten menace. Endoscopy 2003;35:717.
21. Tan HL, Liew QY, Loo S, Hawkins R. Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation. Anaesthesia 2002;57:478-483.
22. National Cancer Institute. Cancer Therapy Evaluation Program. Common Toxicity Criteria Manual. Common Toxicity Criteria, Version 2.0, Publish Date: April 30, 1999. Retrieved on June 27, 2005 from: http://ctep.cancer.gov/reporting/CTC-3.html
23. Murer H, Hernando N, Forster I, Biber J. Regulation of Na/Pi transporter in the proximal tubule. Ann Rev Physiol 2003;65:531-542.
24. Tenenhouse HS. Regulation of phosphorous homeostasis by the type IIa Na/phosphate cotransporter. Ann Rev Nutr 2005;25:197-214.
25. Forster IC, Hernando N, Biber J, Murer H. Proximal tubular handing of phosphate: A molecular perspective. Kidney International advance online publication, 6 September 2006; doi:10.1038/sj.ki.5001813.
26. Stauber A, Radanovic T, Stange G, Murer H, Wagner CA, Biber J. Regulation of intestinal phosphate transport. II. Metabolic acidosis stimulates Na+ -dependent phosphate absorption and expression of the Na+ -Pi cotransporter NaPi- IIb in small intestine. Am J Physiol Gastrointest Liver Physiol 2005;288:G501-G506.
27. Desmeules S, Bergeron MJ, Isenring P. Acute phosphate nephropathy and renal failure. N Engl J Med 2003;349:1006-1007.
28. Markowitz GS, Nasr SH, Klein P, et al. Renal Failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum Pathol
2004;35:675-684.
29. Markowitz GS, Stokes MB, Radhakrishnan J, D’Agati VD. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol 2005;16:3389-3396.
30. Gonlusen G, Akgun H, Ertan A, Olivero J, Truong LD. Renal failure and nephrocalcinosis associated with oral sodium phosphate bowel cleansing. Arch Pathol Lab Med 2006;130:101-106.
31. Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendation for a change in management. Am J Kidney Dis 2001;37:1331-1333.
32. Gamulka BD. Case 2: First do no harm. Paediatr Child Health 2003;8:573-575.
33. Hookey LC, Vanner S. Recognizing the clinical contraindications to the use of oral sodium phosphate for colon cleansing: A case study. Can J Gastroenterol 2004;18:455-458.
34. Geffner M, Opas L. Phosphate poisoning complicating treatment for iron ingestion. Am J Dis Child 1980;134:509 -510.
35. Boivin M, Kahn S. Symptomatic hypocalcemia from oral sodium phosphate: A report of two cases. Am J Gasterenterol 1998;93:2577-2579.
36. Mishra R, Kaufman D, Mattern J, Dutta S. Severe hyperphosphataemia and hypocalcemia caused by bowel preparation for colonoscopy using oral sodium phosphate in end-stage renal disease. Endoscopy 2005;37:1259-1260
37. Patel M, Trigg N, Petropulos T, Berkelhammer C. Colonoscopy bowel preparation in patients with long QT syndrome. Am J Gastroenterol 2005;100:S226.
38. Barclay RL, Depew WT, Vanner SJ. Carbohydrate- electrolyte rehydration protects against intravascular volume contraction during colonic cleansing with orally administered sodium phosphate. Gastrointest Endosc 2002;56:633-638.
39. Tjandra JJ, Tagkalidis P. Carbohydrate- electrolyte (E-Lyte) solution enhances bowel preparation with oral Fleet Phospho-soda. Dis Colon Rectum
2004;47:1181-1186.
40. Love J. The appropriate use of sodium phosphates oral solutions. Can J Gastroenterol 2003;17:531.
41. Hookey LC, Vanner SJ. Recognizing the clinical contraindications to the use of oral sodium phosphate for colon cleansing: a case study. Can J Gastroenterol 2004;18:455-458.