AQUEOUS CATHARTIC SOLUTION

Abstract: An aqueous cathartic solution and method for bowel cleansing is provided. The solution is isotonic, has a minimum buffering effect on human blood and is substantially inorganic. The aqueous solution includes about 3.5 grams/liter of sodium sulfate; about 4.82 grams/liter of magnesium sulfate; about 1.9 grams/liter of sodium bicarbonate; about 3.85 grams/liter of sodium chloride: about 0.746 grams/liter of potassium chloride. To cleanse the bowel between 3.0 and 4.0 liters of the solution are usually administered to a patient.

Description: The present invention relates to an aqueous cathartic solution for bowel cleansing and more particularly to such a solution for bowel cleansing prior to colonoscopy or barium enema x-ray examination. It is known in the art that thorough cleansing of the bowel is needed before either a colonoscopy or a barium enema x-ray examination. To perform either of these diagnostic examinations, the bowel should be free of fecal matter and substantially dry. Many different regimens for cleansing of the bowel are used. Most of these regimens require the ingestion of oral cathartic agents or a solution followed by the administering of cleansing enemas. The use of the cleansing enemas creates both additional discomfort for the patient and additional work for the physician or other medical personnel administering the tests. Many of these prior art regimens use organic substances and/or polyethylene glycol. Polyethylene glycol often is not well tolerated by patients, causes the development of reflectance on the mucus membranes of the colon, creates wetness in the folds of the colon and irritation in the anal area. The organic constituents used in some of these regimens, when metabolized, may create explosive materials which have exploded during certain procedures causing death to the patients. Patient tolerance is an important factor in choosing an appropriate bowel cleansing regimen. Since in lavage regimens the consumption of large quantities of solution is difficult, it is desirable to keep the quantities which must be consumed as small as possible. Further, the palatability of the solution must be considered. For example, certain prior art regimens use an orally administered solution of epsom salts and carbonated water. This solution was not well tolerated because of its taste. An orally administered solution should have little or no effect on blood physiology, osmolarity, pH and ion concentrations. This avoids physiological change. Without proper bowel cleansing, examinations to determine the existence of colorectal diseases and abnormalities, such as malignancies, cannot be done effectively. The foregoing is significant since colorectal cancer is a serious health problem in the United States and other parts of the world. It is presently estimated that in people over the age of 40, one in every one thousand will develop colorectal cancer. It is known that the early detection of such colorectal cancer significantly increases survival rates and further that such early diagnosis enables treatment with less drastic surgical intervention. Additionally, with a lavage solution that does not damage cells, it may be possible to obtain intact cells for cytological analysis while cleansing the bowel. It is an object of the present invention to provide an aqueous, orally administered cathartic solution which cleanses the bowel sufficiently to avoid the need of cleansing enemas. It is another object of this invention to provide such a solution which contains substantially no organic components. Still a further object of this invention is to provide such a solution which prevents the development of reflectance on the mucus membranes of the colon and which further prevents wetness in the folds of the colon. Another object of this invention is to provide such a solution which does not adversely effect the body physiology and chemistry. Yet another object of this invention is to provide such a solution which has maximal cathartic effect with minimal volume intake. The aqueous solution contains, in concentrations substantially similar to their concentrations in human blood, sodium ions and bicarbonate ions. It contains chloride ions in concentrations lower than the concentration of chloride ions in human blood, potassium ions in concentrations higher than the concentration of potassium ions in human blood and magnesium and sulfate ions in concentrations to provide significant cathartic effect. According to the present invention an aqueous solution for cleansing of the bowel comprises: sodium ions in a concentration between 125 mEq and 152 mEq, bicarbonate ions in a concentration between 20 mEq and 30 mEq, chloride ions in concentrations lower than the concentration of chloride ions in human blood; potassium ions in concentrations higher than the concentration of potassium ions in human blood; sulphate ions in a concentration between 117 mEq and 141 mEq, and magnesium ions in a concentration of between 72 mEq and 88 mEq, the solution being substantially inorganic and isotonic. The cathartic solution has a maximal, safe, cathartic effect with a minimal intake of solution and has a minimal buffering effect on body fluids, e.g. human blood. It cleanses the bowel thoroughly enough so that colonoscopy or barium enema x-ray examination can be done without the need of cleansing enemas and provides sufficient intact exfoliated colon cells to permit cell harvesting for cytological examination. In a preferred embodiment of the present invention, an inorganic, isotonic, aqueous cathartic solution is provided. This solution contains about 3.5 grams per liter of sodium sulfate: about 4.82 grams per liter of magnesium sulfate; about 1.9 grams per liter of sodium bicarbonate; about 3.85 grams per liter of sodium chloride; and about 0.746 grams per liter of potassium chloride. The solution has a minimal buffering effect on body fluids, has a low absorption through the intestinal tract and avoids excessive irritation of the intestinal walls and does not damage intestinal cells. The solution of the present invention provides sodium and bicarbonate ions in concentrations substantially similar to their concentration in human blood, potassium ions in concentrations higher than their concentration in human blood, chloride ions in concentrations lower than their concentration in human blood, and magnesium and sulfate ions in concentrations to provide significant cathartic effect. The ionic concentration of the solution prevents adverse effects on body physiology and chemistry caused by ingestion of the solution by providing the solution with its isotonic nature and its ability to have a minimal buffering effect. The ionic makeup of the cathartic solution of the present invention avoids any interference with the major physiological mechanisms of the body. Since sodium ions are among the most abundantly osmotic active ions in the body's extracellular fluid, any substantial change in the concentration of these ions would effect the volume of the extracellular fluid, resulting in hydration. The concentration of bicarbonate ions in body fluids helps keep the pH of the fluids stable. Any substantial change in the concentration of bicarbonate ions can lead to respiratory changes resulting in respiratory acidosis, metabolic acidosis or renal problems. To avoid renal or cardiac problems it is important to avoid lowering the physiologic concentration of potassium ions or raising the physiologic concentration of chlorides. Magnesium and sulfate ions in proper concentrations act as cathartic agents. The concentrations must be such as to avoid any toxic effects. Although the concentrations of these essential ions differ in different body fluids, in blood serum these concentrations in milliequivalents per liter are about: 131 to 147 for sodium ions; 3 to 5 for potassium ions; 6 to 10 for calcium ions, magnesium ions, or a combination of calcium and magnesium ions; 97 to 109 for chloride ions; 21 to 30 for bicarbonate ions. Although our preferred embodiment of the present invention is indicated above, it should be noted that the concentration of constituents can be varied in view of the above range of blood serum ion concentrations. Accordingly, the solution of the present invention, in milliequivalents per liter, may have the following ionic conentration ranges: 68 to 83 for chloride ions; 20 to 25 for bicarbonate ions; and between 9 mEq and 11 mEq for potassium ions. The solution may have an osmolarity of between 260 milliosmomoles and 300 milliosmomoles. The magnesium and sulfate ions of the solution provide maximal cathartic effect. The overall ionic mixture provides minimal disturbance to body chemistry. In order to effectively cleanse the bowel between 3 to 4 liters of the aqueous cathartic solution of the present invention must be ingested by the patient. The solution is generally ingested the night before the colonoscopy or barium enema examination. This volume of solution cleans the bowels sufficiently to make cleansing enemas unnecessary. It has been further found that a clear effluent collected after cleansing of the bowel with this solution contains sufficient intact exfoliated cells to allow cell harvesting for cytological examination. In contrast to prior art bowel cleansing regimens, the solution of this invention does not impart substantial reflectance to the mucus membranes of the colon wall, does not result in substantial wetness of the colon, and is less of an irritant to lesions in the colon and anal regions. Because the solution of the present invention contains substantially no organic matter, there is no problem with development of potentially explosive gases in the colon. The solution of the present invention generally has a minimal effect on blood physiology, minimal absorption from the intestinal tract and is minimally irritating to the intestinal wall.

Claims: An aqueous solution for cleansing of the bowel comprising: sodium ions in a concentration between 125 mEq and 152 mEq, bicarbonate ions in a concentration between 20 mEq and 30 mEq, chloride ions in concentrations lower than the concentration of chloride ions in human blood; potassium ions in concentrations higher than the concentration of potassium ions in human blood; sulphate ions in a concentration between 117 mEq and 141 mEq, and magnesium ions in a concentration of between 72 mEq and 88 mEq, the solution being substantially inorganic and isotonic. The solution of claim 1 wherein thee are between 131 and 147 mEq of sodium ions per liter of solution. The solution as claimed in claim 1 or claim 2 wherein there are between 68 and 83 mEq of chloride ions per liter of solution. The solution as claimed in any one of claims 1 to 3 wherein there are between 20 and 25 mEq of bicarbonate ions per liter of solution. The solution as claimed in any one of claims 1 to 4 wherein there are between 9 and 11 mEq of potassium ions per liter of solution. The solution as claimed in any one of claims 1 to 5 having an osmolarity of between 260 and 300 milliosmomoles per kilogram. The solution as claimed in claim 1 comprising: about 3.5 grams/liter of sodium sulfate; about 4.82 grams/liter of magnesium sulfate; about 1.9 grams/liter of sodium bicarbonate; about 3.85 grams/liter of sodium chloride; about 0.746 grams/liter of potassium chloride; said solution being substantially inorganic. A method of harvesting intact exfoliated colon cells comprising orally administering to a patient about 3.0 to 4.0 liters of a solution as claimed in any one of claims 1 to 7. The use of a solution as claimed in any one of claims 1 to 7 in the preparation of a bowel cleansing agent.

Inventors: HECHTER, HERBERT G.
Applicants: E-Z-EM, INC.
Application year: 1988
Main classification: A61K9
IPC codes: A61K33, A61K9, A61P1