COLONIC PREPARATION WITH PICOLAX - PATIENT TOLERANCE AND APPROACHES TO FLUID REPLACEMENT

Sodium picosulphate (Picolax) is widely used for bo bowel preparation prior to colonic investigation or surgery. The most troublesome side e ffect reported is headache, which has been thought to be due to dehydr ation. In a prospective randomized study we investigated the incidence of adverse effects in patients given Picolax prior to barium enema ex amination, and assessed the incidence of adverse effects with differen t oral fluid regimens. A total of 197 outpatients were allocated to on e of five fluid regimens on the day prior to the enema: (a) 4 pints of Dioralyte (glucose and electrolyte solution); (b) 4 pints of half-str ength Dioralyte; (c) 4 pints of water; (d) 6 pints of water; and (e) f ree fluids. In a questionnaire, 36% of patients had no headache (grade d 0/5), while 38% had a significant headache (graded 3/5 or greater). Sixteen per cent had significant abdominal pain, 42% had dry mouths, 4 3% thirst and 34% tiredness or irritability. There was no correlation between headache and fluid regimen. Furthermore, we have found no evid ence of dehydration. None of the five fluid regimens was shown to offe r any advantage, and we therefore recommend that patients be allowed t o drink according to thirst when taking Picolax.