What are the implications of experiencing symptoms after taking Golytely (Polyethylene Glycol) for bowel prep, with potassium and CO2 levels of 3.3 and 21, respectively?

Management of Electrolyte Abnormalities After Golytely with Hypokalemia and Elevated CO2

Immediate potassium repletion is necessary for this patient with hypokalemia (K 3.3) and metabolic alkalosis (CO2 21, anion gap 17) following Golytely administration. 1, 2

Assessment of Electrolyte Abnormalities

• The patient is experiencing hypokalemia (K 3.3) and metabolic alkalosis (elevated CO2 of 21) with an elevated anion gap (17) following Golytely (polyethylene glycol) administration 2
• PEG-based bowel preparations like Golytely can cause significant electrolyte disturbances, particularly in older patients or those with comorbidities 2
• The incidence of hypokalemia following PEG-based bowel preparations can be as high as 20.5% in vulnerable populations 2

Management Approach

Immediate Interventions:

• Administer oral potassium supplementation for mild hypokalemia (K 3.3) if the patient can tolerate oral intake 2
• Consider IV potassium replacement if the patient is symptomatic or unable to tolerate oral supplementation 2
• Monitor serum electrolytes closely, with repeat measurements within 4-6 hours 2
• Assess for clinical symptoms of hypokalemia including muscle weakness, cardiac arrhythmias, or ileus 2

Addressing Metabolic Alkalosis:

• The elevated CO2 (21) indicates metabolic alkalosis, likely from volume contraction and loss of hydrogen ions during bowel preparation 2
• Normal saline infusion may help correct the metabolic alkalosis by expanding intravascular volume 2
• Monitor acid-base status with repeat blood gas measurements 2

Risk Factors and Prevention

• Elderly patients (≥65 years) are at higher risk for electrolyte disturbances following bowel preparation 2
• Patients with comorbidities such as heart disease, kidney disease, or those taking diuretics are particularly vulnerable 2
• For future colonoscopies, consider:
  • Using lower volume bowel preparation regimens (2L instead of 4L) 1
  • Split-dose administration rather than single-dose administration 1
  • Pre-procedure electrolyte assessment and prophylactic supplementation in high-risk patients 2

Monitoring and Follow-up

• Continue monitoring electrolytes until normalized 2
• Assess for clinical improvement of any symptoms 2
• Consider evaluation for underlying conditions that may have predisposed to these electrolyte abnormalities 2
• Document the adverse event to inform future bowel preparation choices 1

Important Considerations

• Hypokalemia following PEG-based bowel preparations is more common than generally appreciated, occurring in up to 20.5% of elderly hospitalized patients 2
• The FDA label for polyethylene glycol notes that patients may experience loose, watery stools, which can contribute to electrolyte losses 3
• Patients with nausea, vomiting, or abdominal pain should consult a doctor before using PEG-based preparations 3
• For patients with chronic constipation or other risk factors, alternative bowel preparation regimens might be considered in the future 4