Oral mannitol: a simple and effective bowel preparation for barium enema

Poisoning with sustained release potassium

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Comparison of oral lavage methods for preoperative colonic cleansing

Polyethylene glycol electrolyte lavage solution was compared with a 10 percent mannitol solution for preoperative colonic cleansing. Eighty patients were prepared randomly with one of these solutions on the afternoon prior to surgery. Colonic cleansing was better with polyethylene glycol electrolyte lavage (90 percent optimal cleansing vs. 75 percent). Analysis of hematologic, biochemical, and weight changes before and after the bowel preparation, demonstrated a mild subclinical dehydration with the use of mannitol. Evaluation of patient tolerance demonstrated more nausea, cramps, and abdominal pain with mannitol. Other symptoms were similar with both preparations. Colonic hydrogen gas was sampled during surgery, and two patients in the mannitol group had combustible levels. This study confirms that both 10 percent mannitol and polyethylene glycol electrolyte lavage are safe, effective methods of preoperative bowel cleansing. Better cleansing, patient tolerance, and lower hydrogen gas level make polyethylene glycol electrolyte lavage the preferred method.

A 10% mannitol solution effective for colonic preparation for X-ray

Hydroelectrolytic changes, the time of action and complications induced by oral administration of 10 per cent mannitol solution in the colonic preparation for X-ray examination were examined. Twenty-six patients were examined using two different solution volumes: one liter in 15 patients and two liters in 11 patients. No significant biochemical changes were noted. X-ray study of the colon revealed an insufficient evacuation in 3.8 per cent, sufficient in 7.6 per cent, and good in 88.6 per cent of cases. In 6 per cent nausea and vomiting occurred, in 11.7 per cent abdominal distention, and in 7.6 per cent hypotension. This approach was well tolerated, particularly when one liter of the solution was used.

A comparison of mannitol and magnesium citrate preparations for double-contrast barium enema

Three preparations, two based on magnesium citrate and one an optimised oral mannitol regime, have been compared for their effectiveness in clearing the large bowel prior to double-contrast barium enema and for effects on barium mucosal coating. If excellent clearance alone is taken as the criterion of acceptability, the preparations based on magnesium citrate are shown to be equal to each other, but better than mannitol. No significant difference in coating performance is seen between the three preparations. Magnesium citrate regimes cause significantly less nausea and vomiting than mannitol. No differences are noted in the frequency of abdominal or rectal pain between the preparations. It is concluded that mannitol should be abandoned as a barium enema preparation.

Oral mannitol as a preparation for double contrast barium enema

A oral mannitol purgative which is used prior to colonoscopy proved disappointing for barium enema preparation. A number of ways of improving bowel clearance with mannitol in divided dosage, preliminary oral metoclopramide and a clear fluid diet have been assessed. Divided dosage and a clear fluid diet were both beneficial, whereas oral metoclopramide was ineffective. Using the best regime, 38% of patients had a totally clear bowel compared with 33% using an established lavage technique. It is concluded that oral mannitol, with a clear fluid diet, is a satisfactory preparation for double contrast barium enema, and a regime is recommended.

Routine colonic lavage is unnecessary for double-contrast barium enema in outpatients

Four different cleansing regimens were assessed in a prospective survey of 435 patients referred for barium enema. A regimen using simple dietary instructions and laxatives is as effective as a preliminary cleansing enema. It is suggested that routine cleansing enemas in outpatients represent an unnecessary and uncomfortable ritual that might usefully be abandoned.

A randomised trial to investigate X-prep, oral mannitol and colonic washout for double-contrast barium enema

Three methods of bowel preparation used prior to double contrast barium enemas were compared by a randomised trial in 60 patients. Evaluation was by radiological review and from a patient questionnaire. The preparations included X-Prep liquid with colonic washout, oral mannitol alone and oral mannitol with colonic washout. Adequacy of preparation as judged by faecal residue was significantly better after X-Prep than in either group receiving mannitol. The more severe purgation with mannitol did not result in better clearance of the large bowel and the addition of a colonic washout to mannitol did not reduce faecal residue. Side-effects and adverse comments were more common after mannitol. Diarrhoea was significantly less after X-Prep than after mannitol.

Influence of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopic diathermy

Oral mannitol has been widely accepted as the bowel preparation of choice for colonoscopy and elective colorectal operation because it is well tolerated by patients. Recent concern has been expressed regarding the risk of explosion and sepsis using oral mannitol because it may provide a nutrient for certain gas-producing bacteria in the colon. Samples of colonic contents aspirated at operation were compared in patients prepared by oral mannitol, by whole bowel irrigation, mannitol preceded by 48 h of oral antibiotics (neomycin with metronidazole) and in patients who did not undergo any preparation. Significantly higher counts of gas-producing Escherichia coli were recovered from patients prepared with mannitol alone compared with whole bowel irrigation or mannitol preceded by oral antimicrobials. These data are consistent with the hypothesis that fermentation of mannitol by Escherichia coli is responsible for the production of potentially explosive gas mixtures after oral mannitol preparation and may also explain the increased incidence of sepsis when oral mannitol is used for bowel preparation.