Renal failure following bowel cleansing with a sodium phosphate purgative

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1Department of Pathology Columbia University, College of Physicians & Surgeons New York, NY2 Indiana Nephrology & Internal Medicine Indianapolis, IN USA Email: [email protected]

Sir,

Visicol® (InKline Pharmaceutical Co., Inc., Blue Bell, PA, USA) is a tablet form of sodium phosphate used as a bowel purgative prior to colonoscopy. Patients are instructed to take three tablets with at least 8 oz (227 g) clear liquids every 15 min, for a total of 20 tablets, both the evening before and again the morning of colonoscopy. The cumulative dose of 40 tablets contains 44.08 g sodium phosphate monobasic monohydrate (USP) and 15.92 g sodium dibasic anhydrous (USP) for a total of 60 g sodium phosphate. Visicol has been shown to be an effective and safe bowel purgative [1,2]. We describe a case of acute renal failure (ARF) with sustained loss of renal function following use of Visicol.

A 44-year-old Caucasian male presented for evaluation of renal dysfunction. The patient had mild chronic renal insufficiency (CRI) with a creatinine of 1.5 mg/dl (normal range: 0.7–1.5 mg/dl) in August 2002 and 1.7 mg/dl in early December 2003. In early February 2004, the patient was found to have a creatinine of 2.6 mg/dl and was referred for nephrological consultation.