Magnesium Citrate

Magnesium citrate is a saline cathartic that may also be used as a bowel cleansing agent prior to CT colonography. It prevents water resorption and also stimulates cholecystokinin, which causes increased fluid secretion into the small bowel (Bartram 1994). Magnesium citrate comes in either a powder form which is reconstituted with 8 oz (ca. 250 ml) of water or as a premixed solution in a 10-oz (ca. 310 ml) bottle. This is ingested in the late afternoon on the day prior to the procedure with an additional 8 oz (ca. 250 ml) of water. Bisacodyl tablets and suppository are typically used in conjunction with magnesium citrate similar to sodium phosphate.

An advantage of using magnesium citrate is that it is known as a low-sodium preparation. It contains 12 mg of sodium in its mixed form, compared with 5,004 mg of sodium for sodium phosphate. Although in rare instances sodium phosphate has been associated with clinically significant electrolyte disturbances, the use of magnesium citrate has not been found to cause any similar abnormalities. A study found that all patients receiving sodium phosphate had significant elevations in phosphorus levels followed by a decline in serum calcium levels compared with patients receiving magnesium citrate (Oliviera et al. 1998).

Magnesium citrate has been used with a reduced total volume of polyethylene glycol lavage solution prior to colonoscopy as a strategy to improve patient compliance and tolerance. This has also been found to improve the quality of colonic cleansing and to decrease preparation times (Sharma et al. 1998).

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