COLONOSCOPY INSTRUCTIONS USING MIRALAX (SPLIT DOSE)

You have been scheduled for a colonoscopy. This is an examination of your large intestine (colon). A thin flexible tube (colonoscope) will be inserted into your rectum and passed through your colon. Your colon will be examined in detail. Additional procedures may be performed, such as taking tissue samples (biopsies) and removing polyps.

Please read all of the instructions ahead of time so you are adequately prepared for this procedure.

PURCHASE AT YOUR PHARMACY, GROCERY STORE, WAL-MART, OR TARGET
(ALL OVER THE COUNTER)
- One Bottle of Miralax Powder 238 grams (Polyethylene Glycol PEG 3350). No prescription needed.
- Two quarts (64 fluid ounces) of any non-carbonated clear liquid; such as Gatorade, PowerAde,
iced
tea. No red, purple or blue coloring.
- Diabetic Patients: Use two quarts (64 fluid ounces) of sugar free clear liquids, such as CrystalLight,
Gatorade G2 or diet iced tea. No red, purple or blue coloring.
SPECIAL INSTRUCTIONS FROM YOUR HEALTH PROVIDER
1.
2..
THE DAY BEFORE YOUR PROCEDURE
- Before 10am you may eat a breakfast consisting of scrambled eggs, any white bread, lean breakfastmeat.
No fruits, vegetables or cereal. No foods containing fiber.
- After 10am drink only clear liquids. No red, purple or blue coloring.
CLEAR LIQUIDS ARE LIQUIDS THAT YOU CAN SEE THROUGH.
NO LIQUIDS WITH PULP OR MILK PRODUCTS. NO ALCOHOLIC BEVERAGES.
  • Clear Soups: chicken, turkey, beef or vegetable bouillon/broth.
  • Beverages: Water, tea and coffee with sugar/sweetener (no cream/milk), Kool-Aid, Gatorade,
Powerade,carbonated beverages.No red, purple or blue coloring.
  • Juices: Whitecranberry and white grape juice, apple juice, lemonade without pulp.
  • Dessert: Italian ices, popsicles, Jell-O, hard candy.No red, purple or blue coloring.
THE DAY BEFORE YOUR PROCEDURE
  1. At 5:00 pm mix Miralax Powder 238 grams (Polyethylene Glycol PEG 3350) in two quarts (64 oz) of
any non-carbonated clear liquid; such as Gatorade, PowerAde, iced tea.No red, purple or bluecoloring.
  1. Mix until Miralax is dissolved.
  2. Drink the first quart (32 oz). One cup (8oz) every 15 minutes as tolerated, until a total of four cups are completed.
  3. You may continue to have clear liquids until midnight. NOTHING TO EAT OR CHEW AFTER MIDNIGHT.
It is very important to increase your fluid intake. This will help to prevent dehydration.
THE DAY OF YOUR COLONOSCOPY
  1. At______am (4hrsbefore arrival time at the Endoscopy Center) on ______
drink2nd quart (32 oz) of laxative drink,one cup (8oz) every 15 minutes as tolerated until a total of four cups are completed.
2.Then nothing more by mouth except medications with a sip of water as directed.
YOUR APPOINTMENT
DATE:______ARRIVAL TIME:______
Unless instructed otherwise please DO NOT arrive earlier than the above scheduled time.
Riverwalk Endoscopy Center Gulf Coast Medical Center LMHS Outpat. Surgery Ctr
8380 Riverwalk Park Blvd #220 13681 Doctors Way 8970 Colonial Center Drive
Fort Myers, FL 33919 Fort Myers, FL 33912 Fort Myers, FL 33908
239-454-7544 239-343-1000 239-343-9600
  • PLEASE MAKE ARRANGEMENTS FOR A RESPONSIBLE ADULT
(NOT A TAXI SERVICE) TO DRIVE YOU HOME.
  • NO DRIVING UNTIL THE FOLLOWING MORNING.

05/13