Acute Renal Failure after Ingestion of Polyethylene Glycol Electrolyte Lavage Solution for Bowel Preparation in a Chronic Spinal Cord Injury Patient: A Case Report

慢性脊髓損傷患者於腸道準備中服用聚乙二醇溶液導致急性腎衰竭：病例報告

柯蘋芯(Ping-Hsin Ko) ； 黃雅鈴(Ya-Ling Huang) ； 王顏和(Yen-Ho Wang) ； 梁蕙雯(Huey-Wen Liang) ； 潘信良(Shin-Liang Pan)

《台灣復健醫學雜誌》 37卷1期 (2009/03) Pp. 45-50

https://doi.org/10.6315/2009.37(1)05

摘要

靜脈腎盂造影是評估脊髓損傷患者上泌尿系統常用的影像檢查。患者接受檢查前，通常需要進行腸道準備以確保良好的影像品質，而腸道準備所使用的製劑中，以聚乙二醇電解質溶液（商品名刻見清）較少有嚴重副作用，較爲安全。然而，仍有少數報告其併發症。本病例報告描述一位脊髓損傷患者，爲了腸道準備而服用聚乙二醇電解質溶液，不料併發急性腎衰竭。一位57歲女性慢性脊髓損傷患者，住院接受骨骼傷害之治療與泌尿系統追蹤檢查，剛入院檢查時，血液中的尿素氮、肌酸酐與其他電解質皆在正常範圍。在腸道準備過程中，她口服500毫升的聚乙二醇電解質溶液，約半小時後，產生了輕微的嘔吐與上肢紅疹，二十個小時後，患者尿量減少，檢查結果證實爲急性腎衰竭。檢驗報告另發現了輕微的代謝性酸中毒，尿液中有新產生的草酸鈣晶體沉積，上述徵候皆與乙二醇中毒的症狀相似。藉此例報告，建議於腸道準備過程中，應留意可能的腎併發症，危險性較高的病人需監測其體液狀態。

關鍵字

腎衰竭 ； 腸道準備 ； 聚乙二醇

並列摘要

Intravenous pyelography (IVP) is a common tool for evaluating the upper urinary tract in spinal cord injury patients. To obtain a proper image, bowel preparation is required. Among the regimens for bowel preparation, polyethylene glycol (PEG) electrolyte lavage solution has a good cleansing quality and fewer side effects. Nonetheless, adverse effects of the regimen, though rare, have been reported. We describe a spinal cord injury patient who suffered from acute renal failure as a result of PEG-related toxicity, after taking oral PEG electrolyte lavage solution for bowel preparation. A 57-year-old woman who had sustained spinal cord injury for 11 years was admitted for orthopedic problems and the follow-up of urinary system. Her serum blood urea nitrogen, creatinine, and electrolytes were within normal ranges on admission. She took 500 mL of PEG electrolyte lavage solution for bowel preparation. Mild vomiting and skin rash were noted 30 min later. Moreover, oliguria developed within the next 20 h so she was diagnosed with acute renal failure. The presence of metabolic acidosis and urinary calcium oxylate crystals were noted, so PEG-related oliguric acute tubular necrosis was suspected. The above symptoms were similar to those seen with ethylene glycol intoxication. We conclude that bowel preparation with PEG lavage solution may be associated with severe renal complications, and that physicians should be aware of possible adverse effects when administering the agent.

並列關鍵字

renal failure ； bowel preparation ； polyethylene glycol