Severe rhabdomyolysis and hyponatremia induced by picosulfate and bisacodyl during the preparation of colonoscopy.

A 57-year-old woman was admitted for a generalized tonicclonic seizure. She had clinical history of hypothyroidism, migraine and hypercholesterolemia. The patient was scheduled a colonoscopy for investigation of rectal tenesmus. Three days before she had initiated a bowel preparation based on a liquid diet. The day of admission, the patient had an elevated water intake and she had taken two sachets of CitraFleet and two tablets of bisacodyl. On examination, the patient presented temporal disorientation, indifferent right cutaneous plantar reflex and lack of neck stiffness or other alterations. Biochemical results are reported in Table I. The main findings were serum sodium of 120 mEq/l and an initial creatine phosphokinase (CK) levels of 429 IU/l that reached a maximum level of 30778 IU/l. Brain CT showed a small chronic infarction, and no other relevant findings. Due to the presence of neurological symptoms, a 3 % saline infusion was initiated at a rate of 1.5 ml/kg/h. After two hours of treatment, sodium levels increased and neurological symptoms resolved and treatment was switched to a 0.9 % saline infusion. Regarding CK levels, they increased during the first 72