A recent study (B Sahn et al. JPGN 2016; 63: 19-24) with 155 patients prospectively showed that a 1-day polyethylene glycol (PEG) 3350 prep was safe and fairly effective.
The prep: 4 g/kg PEG in children with weights 10-50 kg and (with 238 gm for those >50 kg along with a single dose of a stimulant: either bisacodyl 5 mg-15 mg orally (10 mg for 21-30 kg) or senna (17.6 mg for 20 kg, 26.4 mg for 21-30 kg, and 52.8 mg for >31 kg). The PEG was mixed typically with a sports drink to a max of 64 oz.
- Hypokalemia was noted in 37 (24%) but none lower than 3.3 mmil/L.
- Hypoglycemia was identified in 5 (3 were younger than 7). The one patient with severe hypoglycemia (31 mg/dL) was a one-year-old with corticosteroid dependency and had missed his morning steroid dose.
- Colon cleansing was excellent or good in 77%. The authors note that this suboptimal cleansing is due in part to the difficulty of using split-dosing in pediatrics.
- 3/4ths of patients found the prep to be easy or average to tolerate.
My take: This study validates the common approach of using 1-day PEG 3350 preps in children. Due to the low risk of hypoglycemia, particularly in young children, and the frequent mild hypokalemia, some children may benefit from starting intravenous fluids prior to induction of anesthesia.
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