Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 187-192
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.187
Hyponatremic encephalopathy due to polyethylene glycol-based bowel preparation for colonoscopy: A case report
Yuan Zhao, Hai-Sheng Dong
Yuan Zhao, Hai-Sheng Dong, Department of Critical Care Medicine, Shanghai TCM-integrated Hospital, Shanghai 200082, China
Author contributions: Zhao Y and Dong HS designed the study; Zhao Y performed the study, collected and analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient after treatment for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Sheng Dong, MD, Doctor, Department of Critical Care Medicine, Shanghai TCM-integrated Hospital, No. 230 Baoding Road, Hongkou District, Shanghai 200082, China. hsdong06@163.com
Received: September 23, 2022
Peer-review started: September 23, 2022
First decision: October 30, 2022
Revised: November 11, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 6, 2023
Processing time: 103 Days and 18.6 Hours
Abstract
BACKGROUND

Adequate bowel preparation is critical for colonoscopy screening. At present, the most widely used intestinal cleaner recommended at home and abroad is Polyethylene glycol (PEG). Intestinal cleansers can cause electrolyte disturbances and hyponatremia. However, hyponatremic encephalopathy due to hyponatremia induced by PEG solution, although rare, can lead to serious irreversible sequelae and even death.

CASE SUMMARY

In this report, we discuss a case of neurological dysfunction due to hyponatremia, also known as hyponatremic encephalopathy, observed in a 63-year-old woman who underwent PEG-based bowel preparation for colonoscopy. She was eventually transferred to our intensive care unit for treatment due to her Glasgow Coma Scale score of 9/15 (Eye opening 2; Verbal response 1; Motor response 6) and abnormal laboratory tests.

CONCLUSION

Physicians should be thoroughly familiarized with the patient's history before prescribing PEG for bowel preparation, and timely identification of patients with hyponatremic encephalopathy is essential as delayed treatment is associated with poor neurological outcomes. An intravenous infusion of 3% sodium chloride is recommended at the onset of early symptoms. The goal of treatment is to adequately treat cerebral edema while avoiding serum sodium correction beyond 15 to 20 mEq/L within 48 h of treatment to prevent osmotic demyelination syndrome.

Keywords: Polyethylene glycol; Intestinal preparation; Hyponatremic encephalopathy; Hyponatremia; Brain; Case report

Core Tip: Hyponatremic encephalopathy caused by the use of polyethylene glycol (PEG) solution for intestinal cleaning is rare, which can lead to irreversible sequelae and even death. This case is a female with neurological dysfunction due to hyponatremia induced by the use of pegylated for bowel preparation before colonoscopy. The patient was in a coma with the brain suggesting cerebral edema, and was transferred to the intensive care unit for treatment with 3% sodium chloride injection. The patient's medical history should be fully understood before using PEG for bowel preparation, as both untimely and overtreatment can lead to serious complications.