An elderly patient who receives oral sodium phosphate for bowel cleansing may develop hyperphosphatemia, hypokalemia and other electrolyte disorders. Beloosesky et al identified a number of risk factors predisposing to these changes. The authors are from Rabin Medical Center and Tel Aviv University in Israel.


Patient selection: >= 65 years of age


Administration of oral sodium phosphate may result in:

(1) hyperphosphatemia

(2) hypernatremia

(3) hyperchloremia

(4) hypokalemia

(5) hypocalcemia


Risk factors for developing hyperphosphatemia and electrolyte abnormalities:

(1) renal insufficiency (with reduced creatinine clearance and impaired potassium conservation)

(2) frail and dependent

(3) cognitive impairment (dementia)

(4) pre-existing hypocalcemia, hypokalemia or hyperphosphatemia


A patient with pre-existing cardiovascular disease may be at greater risk for complications if electrolyte abnormalities develop.


A patient with one or more risk factors should be carefully evaluated before and after use of oral sodium phosphate:

(1) measurement of serum creatinine and calculation of creatinine clearance

(2) monitoring of serum phosphorus, sodium, calcium and potassium


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