Effects of oral sodium picosulphate Picolax on urea and electrolytes.

AIM: To investigate the effects of sodium picosulphate (Picolax) oral bowel preparation on levels of serum urea, electrolytes and glucose in patients undergoing bowel preparation for barium enema. METHOD: A prospective, non-randomised, pre-test and post-test trial was conducted with 144 patients aged 34-87 years, who had agreed to undergo a barium enema. Changes in serum urea, sodium, potassium, magnesium and glucose following Picolax treatment were investigated. RESULTS: There were statistically significant post-Picolax reductions in serum concentrations of urea (mean difference 0.556 (95 per cent confidence intervals (CI) 0.321-0.791) mmol/L), sodium (mean difference 1.299 (0.799-1.799) mmol/L) and potassium (mean difference 0.163 (0.0853-0.241) mmol/L). Similar findings were observed for sodium and urea when the sample was stratified according to age: under 60 years (n=56) or 60 years and over (n=88). However, there was no significant change in potassium in patients aged under 60 years. CONCLUSION: In normal circumstances, use of Picolax oral bowel preparation results in a statistically, but not clinically, significant reduction in concentration of serum urea, sodium and potassium.

Bile acid stress in the mother and baby unit.

Intrahepatic cholestasis of pregnancy (ICP) affects about 0.7% of deliveries in Britain. It is regarded as a benign condition for the mother but is associated with increased fetal mortality in late pregnancy and early delivery is advised. Ursodeoxycholic acid (UDCA) treatment is beneficial to the mother and does not appear to harm the fetus. ICP is often regarded as a disease of the maternal liver already made 'cholestatic' by high levels of circulating progesterone. We propose that ICP should be considered as a feto-maternal disease involving complex interactions between maternal and fetal bile acid metabolism across the placenta. During the late stages of gestation, when there is a rise in fetal and maternal bile acid levels, the placenta may fail to render potentially hepatotoxic bile acids water soluble and hence excretable. This might cause a vicious cycle leading to further cholestasis in the maternal liver already challenged by progesterone.