Table 1.
Bowel preparation under special conditions
| Special condition | Considerations for appropriate bowel preparation |
| Elderly | Avoid NaP to reduce risk of electrolyte imbalance and phosphate accumulation |
| Childhood | 1.25 mg/kg PEG for 4 d with liquid diet on the fourth day |
| Pregnancy | PEG may be preferable to NaP |
| Breastfeeding | Interrupt breastfeeding during and after bowel preparation |
| Severe/chronic constipation | Extend the liquid diet requirement |
| Alternate the bowel preparation agent (PEG or NaP) | |
| Provide adjunctive laxative agents (magnesium citrate, bisacodyl, or senna) | |
| Apply a combined bowel preparation agent (both PEG and NaP) or double the dosage of PEG solution | |
| Stroke, dementia | If patients have difficulty swallowing, provide the bowel preparation agent via endoscopic irrigation pump or nasogastric tube |
| IBD | NaP and sodium picosulfate plus magnesium citrate should be avoided because of mucosal damage and irritation |
| Diabetes | Appropriate dose and proper tempo of fluid intake is important because of delayed colonic transit time |
| NaP should be avoided due to possible risk of hyperphosphatemia, metabolic acidosis, and renal failure | |
| Hypertension | NaP should be cautiously applied in patients taking a drug that affects renal function (diuretics, ARB, ACEi) |
| Chronic kidney disease | NaP preparation is not recommended because of increased risk of renal dysfunction |
| Congestive heart failure | PEG solution should be cautiously applied because of an association with increased intravascular volume |
| NaP preparation is not recommended because of electrolyte imbalance and volume loss | |
| Lower GI bleeding | PEG solution may be more effective than enema |
| If a rectal bleeding focus is suspected or severe bleeding is present, enema can be useful |
NaP: Sodium phosphate; PEG: Polyethylene glycol; ARB: Angiotensin receptor blockers; ACEi: Angiotensin converting enzyme inhibitors; IBD: Inflammatory bowel disease; GI: Gastrointestinal.