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

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. ( Tw J Phys Med Rehabil 2009; 37(1): 45 – 50 )