This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ezri, T. Articles by Shimonov, M. Search for Related Content PubMed PubMed Citation Articles by Ezri, T. Articles by Shimonov, M.

Phosphate salt bowel preparation regimens alter perioperative acid-base and electrolyte balance

[Les préparations intestinales aux sels phosphatés modifient l’équilibre périopératoire acide-base et électrolytique]

Tiberiu Ezri, MD^*,, Emma Lerner, MD, Michael Muggia-Sullam, MD, Benjamin Medalion, MD^¶, Alexander Tzivian, MD, Abraham Cherniak, MD^**, Peter Szmuk, MD and Mordechai Shimonov, MD

^* From the Departments of Anesthesia,
Internal Medicine "B",
Surgery "B",
^¶ Cardiothoracic Surgery,
^** Urology, Surgery "A",
Anesthesiology, The University of Texas Medical School at Houston, TX;
Surgery "A", Wolfson Medical Center, Holon, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel; and the
Outcomes Research^TM Institute, University of Louisville, Kentucky, USA.

Address correspondence to: Dr. Peter Szmuk, Department of Anesthesiology, The University of Texas Medical School at Houston, 6431 Fannin, MSB 5.020, Houston, Texas 77030, USA. E-mail: peter.szmuk{at}uth.tmc.edu

Background: Hyperphosphatemic acidosis and severe electrolyte disturbances caused by phosphate salts (PO) used for mechanical bowel preparation have been described in occasional case reports prior to bowel resection surgery. We hypothesized that PO used preoperatively for bowel preparation may cause more pronounced acid base and electrolyte changes than polyethylene glycol (PG).

Methods: Forty American Society of Anesthesiologists physical status II–III patients were randomly allocated to receive either PO or PG for bowel preparation before intra-abdominal surgery (bowel resection or other major elective intra-abdominal surgeries). Measurements of pH, base deficit, blood gases, lactate, hemoglobin, calcium, magnesium, potassium and phosphorus were undertaken before the laxative administration, intraoperatively, and postoperatively.

Results: Preoperative demographic, hemodynamic and laboratory data were similar in the two groups. Intraoperative calcium (8.4 [0.6] vs 9 [0.5] mg·dL^–1) and pH (7.35 [0.04] vs 7.41 [0.03]) were lower, while lactate (1.3 [0.4] vs 0.9 [0.3] mmol·L^–1) was higher with PO. Postoperative calcium, magnesium and potassium were lower (8 [0.5] vs 8.9 [0.2] mg·dL^–1, 1.68 [0.3] vs 1.8 [0.4] and 3.5 [0.36] vs 3.7 [0.33] mEq·L^–1 respectively) while phosphorus (4.1 [0.3] vs 3.3 [0.2] mEq·L^–1) was higher with PO. A higher percentage of abnormal values for calcium, potassium, phosphorus and base deficit (66% vs 33%, 25% vs 10%, 19% vs 2% and 28.3% vs 5% respectively) were observed with PO.

Conclusions: Calcium and magnesium changes were more pronounced in patients who received PO for bowel preparation.

This article has been cited by other articles:

				M. Caswell Phosphate salt bowel preparation regimens alter perioperative acid-base and electrolyte balance. Can J Anesth, September 1, 2006; 53(9): 961 - 961. [Full Text] [PDF]

				T. Ezri, P. Szmuk, and M. Muggia-Sullam REPLY Can J Anesth, September 1, 2006; 53(9): 961 - 961. [Full Text] [PDF]