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Severe hypernatraemia, hyperphosphataemia, metabolic acidosis and renal failure secondary to the administration of cleansing enemas
Hipernatremia grave, hiperfosforemia, acidosis metabólica y fracaso renal secundarios a la administración de enemas de limpieza
G.. Vega Tejedora, Carlos Ruiz-Zorrilla Lópezb, F.J.. Soler Gonzáleza, R.. Ruiz-Zorrilla Lópezc, F.. Rodríguez Martínb, A.. Acebal Botínb
a Servicio de Medicina Interna, Hospital Río Hortega, Valladolid, España,
b Servicio de Nefrología, Hospital Río Hortega, Valladolid, España,
c Servicio de Digestivo, Hospital Río Hortega, Valladolid, España,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;&#160;</span>Colonoscopy preparation solutions are&#160;widely used due to their rare side&#160;effects&#46; However&#44; we must exercise&#160;caution when using them in extremely&#160;old or young patients and those with&#160;digestive and&#47;or renal diseases&#46;<span class="elsevierStyleSup">1&#160;</span>In patients with renal failure&#44; it may&#160;trigger severe electrolyte imbalances&#44;&#160;including severe hypernatraemia&#44;&#160;hyperphosphataemia&#44; hypokalaemia&#44;&#160;metabolic acidosis or renal failure&#160;secondary to dehydration&#46; We herein&#160;describe a case with those alterations&#160;and severe clinical consequences&#46;&#160;Male patient aged 30 years with a&#160;history of congenital encephalopathy&#160;and secondary mental retardation&#44;&#160;congenital digestive disorder&#44; chronic&#160;renal polycystic changes with severe&#160;long-term ureterohydronephrosis and&#160;secondary chronic renal failure with&#160;recurring urinary tract infections&#46; The&#160;patient is a dependent for all life&#160;activities&#46; He was admitted due to a&#160;partial ileus &#40;figure 1&#41; secondary to&#160;foreign objects &#40;plastics&#44; soil&#44; etc&#46;&#41;&#44;&#160;with unremarkable blood chemistry&#160;except for a serum creatinine &#40;Cr&#41; level&#160;of 1&#46;4mg&#47;dl that he already presented&#160;in previous laboratory tests&#46; From the&#160;time he was admitted&#44; he was treated&#160;with abundant fluid therapy and&#160;cleansing enemas&#44; and various types of&#160;foreign bodies were obtained over the&#160;following three days&#46; On the fourth day&#160;after admission his state of&#160;consciousness began to deteriorate&#160;progressively and the blood test&#160;showed the following&#58; Cr&#44; 5mg&#47;dl&#59;&#160;urea&#44; 116mg&#47;dl&#59; Na&#44; 197mmol&#47;l&#59; K&#44;&#160;2&#46;6mmol&#47;l&#59; Cl&#44; 159mmol&#47;l&#59; pH&#44; 7&#46;2&#59;&#160;HCO<span class="elsevierStyleSup">3</span>&#44; 14&#46;9mmol&#47;l&#59; GAP&#44; 23&#59; Ca&#44;&#160;7&#46;4mg&#47;dl&#59; P&#44; 14&#46;9mg&#47;dl&#44; and osmolarity 389mOs&#47;kg&#46; Given data indicating renal&#160;failure&#44; normochloraemic metabolic&#160;acidosis&#44; hypernatraemia&#44; hypokalaemia&#160;and hyperphosphataemia&#44; and their&#160;severe clinical repercussions&#44; we&#160;decided to perform a session of&#160;haemodialysis&#44; and the patient&#160;responded well&#46; After two additional&#160;haemodialysis sessions we obtained&#160;electrolyte levels within the normal&#160;range and resolution of the neurological&#160;syndrome that had occurred&#46; When the&#160;patient was discharged from the&#160;hospital&#44; nitrogen retention levels had&#160;been stabilised and were similar to those&#160;at time of admission&#46;&#160;Due to the low clinical suspicion of&#160;this condition&#44; diagnosis and initiation&#160;of treatment are often delayed&#44; and for&#160;that reason&#44; mortality is between 17&#160;and 33&#37; depending on the series&#46;<span class="elsevierStyleSup">2&#160;</span>To conclude&#44; we must evaluate the&#160;risk-benefit continuum before using a&#160;colonoscopy preparation and if it is&#160;necessary&#44; use preparations specially&#160;designed for patients with renal failure&#44;&#160;such as XPrep&#46;<span class="elsevierStyleSup">3&#44;4&#160;&#160;&#160;</span></p><p class="elsevierStylePara"><a href="grande&#47;10342108&#95;a22&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10342108_a22_f1.jpg" alt="Simple radiography of patient&#39;s abdomen at admission&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Simple radiography of patient&#39;s abdomen at admission&#46;</p>"
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ISSN: 20132514
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