Kolonoskopi Hazırlığında Su İntoksikasyonu ve Hiponatremi Kaynaklı Epileptik Atak Vaka Serileri İncelemesi: Hemşirelik Bakımı ve Yönetiminde Kritik Noktalar

Öz

Kolonoskopi öncesi bağırsak hazırlığı çoğunlukla güvenli olmakla birlikte, özellikle aşırı sıvı alımı ve eşlik eden ilaç kullanımı elektrolit dengesizliklerine yol açabilmektedir. Bu literatür bazlı vaka serileri incelemesi, polietilen glikol (PEG) bazlı bağırsak hazırlığı sonrasında görülen hiponatremi ve buna bağlı epileptik nöbet gelişimini hemşirelik bakım ve yönetimi açısından değerlendirmeyi amaçlamaktadır. Bu derlemede, polietilen glikol (PEG) bazlı bağırsak hazırlığı sonrası gelişen şiddetli hiponatremi ve epileptik nöbet olguları, hemşirelik bakım perspektifinden sunulmaktadır. Olgu 1: Yetmiş iki yaşında erkek hastada, split-dose PEG sonrası aşırı sıvı tüketimi ve desmopressin kullanımı ile birlikte Na: 112 mEq/L’ye düşen hiponatremi ve jeneralize tonik-klonik nöbet gelişmiş, hipertonik salin tedavisi ile semptomlar düzelmiştir. Olgu 2: Yetmiş beş yaşında kadın hasta, 4 L PEG ve eşlik eden tiazid diüretik uygulaması sonrası benzer şekilde hiponatremi (Na: 112 mEq/L) ve nöbet geçirmiş, uygun tedavi ile semptomlar tamamen gerilemiştir. Olgu 3: Doksan bir yaşında kadın hasta, PEG sonrası hiponatremi (Na: 115 mEq/L) ve nöbet tablosu ile başvurmuş, sıvı-elektrolit tedavisi sonrası klinik düzelme sağlanmıştır. Ortak bulgu, PEG kullanımını takiben şiddetli hiponatremi gelişmesi ile birlikte epileptik nöbet ortaya çıkmasıdır. Tüm olgularda erken tanı ve uygun tedavi ve bakım ile iyileşme sağlanmıştır. Sonuç olarak, hemşirelik bakımında sıvı alımının kontrolü, riskli ilaçların değerlendirilmesi, yaşlı ve komorbid hastaların yakın takibi ile elektrolit bozukluklarının erken fark edilmesi hasta güvenliği açısından kritik öneme sahiptir.

Anahtar Kelimeler

• Jeneralize nöbetler
• hemşirelik bakımı
• bakımı
• kolonoskopi

Case Series Review of Epileptic Seizures Caused by Water Intoxication and Hyponatremia During Colonoscopy Preparation: Critical Points in Nursing Care and

Öz

Although bowel preparation prior to colonoscopy is generally safe, excessive fluid intake and concomitant medication use can lead to electrolyte imbalances. This literature-based case series review aims to evaluate hyponatremia and the development of associated epileptic seizures following polyethylene glycol (PEG)-based bowel preparation from a nursing care and management perspective. This literature review presents cases of severe hyponatremia and epileptic seizures following polyethylene glycol (PEG)-based bowel preparation from a nursing care perspective. Case 1: A 72-year-old male patient developed hyponatremia (Na: 112 mEq/L) and generalized tonic-clonic seizures following excessive fluid consumption and desmopressin use after split-dose PEG; symptoms resolved with hypertonic saline treatment. Case 2: A 75-year-old female patient experienced similar hyponatremia (Na: 112 mEq/L) and seizures after 4 L of PEG and concomitant thiazide diuretic administration; symptoms completely resolved with appropriate treatment. Case 3: A 91-year-old female patient presented with hyponatremia (Na: 115 mEq/L) and seizures following PEG administration. Clinical improvement was achieved after fluid and electrolyte therapy. The common finding is the development of severe hyponatremia following PEG administration, accompanied by epileptic seizures. In all cases, recovery was achieved with early diagnosis and appropriate treatment and care. In conclusion, controlling fluid intake in nursing care, evaluating high-risk medications, closely monitoring elderly and comorbide patients, and early detection of electrolyte imbalances are critical for patient safety.

Anahtar Kelimeler

• Colonoscopy
• convulsive seizure
• hyponatremia
• nursing care

Kaynakça

1. 1. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2021;161(4):1125-45.
2. 2. Lieberman D, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy. Gastroenterology. 2016;150(3):785–93.
3. 3. Johnson DA, Barkun AN, Cohen LB, Dominitz JA, Kaltenbach T, Martel M, ve ark. Optimizing adequacy of bowel cleansing for colonoscopy: Recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2014;109(10):1528–45.
4. 4. ASGE Standards of Practice Committee, Saltzman JR, Cash BD, Pasha SF, Early DS, Muthusamy VR, ve ark. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81(4):781–94.
5. 5. Hookey LC, Vanner S. A review of current issues underlying colon cleansing before colonoscopy. Can J Gastroenterol Hepatol. 2017;2017:8949454.
6. 6. Markowitz GS, Nasr SH, Klein P, Kim DH. Drug-induced electrolyte disorders. N Engl J Med. 2020;382(19):1831-43.
7. 7. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2013: Expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-42.
8. 8. Chiang T-H, Tan J-H, Chang C-C, Fang K-C. Seizure from water intoxication following bowel preparation: a case report. BMC Nephrol. 2022;23:271.

9. 9. Lee MH, Lee BH, Oh SK, Seo JY, Kim HJ, Seo BJ. Acute severe hyponatremia with seizure following polyethylene glycol-based bowel preparation for colonoscopy. Kosin Med J. 2012;27(2):173-6.
10. 10. Seyrafian S, Sebghatollahi V, Bastani B. Hyponatremia-induced generalized seizure after taking polyethylene glycol for colon preparation: A case report and brief review of the literature. Clin Case Rep. 2022;10(8):e6247.
11. 11. Khurana A, Singhal S, Sabharwal BD. Hyponatremia after bowel preparation: A case series and review of literature. J Dig Endosc. 2019;10(3):173-7.
12. 12. American Society for Gastrointestinal Endoscopy (ASGE). Guideline on bowel preparation before colonoscopy. Gastrointest Endosc. 2021;93(2):437-58.
13. 13. Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74(4):885–896.
14. 14. Hassan C, Bretthauer M, Kaminski MF, Polkowski M, Rembacken B, Saunders B, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013;45(2):142–50.
15. 15. Gupta S, Wang A, Akinnusi M, Pandit V. Hyponatremia in the elderly: challenges and management. Clin Interv Aging. 2020;15:205–15.
16. 16. Hobson P, Foy A. The role of nurses in safe bowel preparation: hydration, electrolyte monitoring, and patient education. Gastroenterol Nurs. 2019;42(1):45–53.
17. 17. Sharara AI, Abou Fadel C, Biggs D, Waye JD. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2016;111(4):542–9.
18. 18. Miller JL, Btaiche IF. Electrolyte and fluid disturbances in older adults. J Gerontol Nurs. 2019;45(6):21–30.
19. 19. Askarian M, Yazdanpanah A, Khorasani-Zavareh D. Nursing responsibilities and patient safety during colonoscopy preparation: A systematic review. J Patient Saf. 2021;17(8):e1525–32.