From the Research
Electrolyte Imbalances Caused by Tap Water Colonic Irrigation
- Tap water colonic irrigation can cause electrolyte imbalances, including hyponatremia (low sodium levels) and hypernatremia (elevated sodium levels) 1, 2.
- Hyponatremia is a rare complication of colonic irrigation with tap water, especially in children, and can be severe enough to cause symptoms such as persistent hiccups 1.
- The use of tap water treated with a home softening system for colonic irrigation can lead to significantly elevated sodium and chloride levels, which can cause hypernatremia 2.
- However, the risk of significant hyponatremia or hypochloremia in patients using tap water for colonic irrigation is low, and periodic evaluation is recommended to detect potential electrolyte abnormalities 2.
Factors Contributing to Electrolyte Imbalances
- The type of bowel cleansing solution used, age of patients, and comorbidities can contribute to the risk of electrolyte imbalances during bowel preparation for colonoscopy and/or colorectal surgery 3.
- Patients older than 65, those taking certain medications (such as thiazide diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, and antidepressants), and those with previous gastrectomy are at higher risk of developing electrolyte imbalances 3.
- The use of sodium phosphate-based solutions and sodium picosulfate/magnesium citrate can increase the risk of electrolyte imbalances, and macrogol-based solutions (polyethylene glycol) are recommended for patients at high risk 3.
Clinical Management of Electrolyte Imbalances
- Disorders of sodium and water balance, including hyponatremia and hypernatremia, are common in hospitalized patients and can be iatrogenic 4.
- These disorders can be caused by various factors, including excess or deficit of total body water relative to total body sodium content, and can be classified as hypo-osmolar or hyper-osmolar 4.
- Timely recognition and appropriate intervention are crucial to reverse electrolyte imbalances and prevent serious morbidity and increased risk of death 4.
- The management of hyponatremia should consist of treating the underlying cause, and urea and vaptans can be effective treatments for the syndrome of inappropriate antidiuresis and hyponatremia in patients with heart failure 5.
- Severely symptomatic hyponatremia is a medical emergency and should be treated with bolus hypertonic saline to reverse hyponatremic encephalopathy 5.