Text of PREP 004 Magnesium Citrate Dulcolax Prep Word - PREP 004 Magnesium Citrate Dulcolax Prep
09/11/12 PREP: 1S/1P-004
MAGNESIUM CITRATE & DULCOLAX PREP INSTRUCTIONS
Doctor: ___________________________ Date of Procedure: _______________________
o AM Location: o West Columbia Arrive Time: _______________ o PM o Northeast o Other: ____________________ On the day before your procedure:
DO NOT EAT SOLID FOOD.
DRINK CLEAR LIQUIDS ONLY.
Any of the following are acceptable. (Please avoid RED and PURPLE fluids.)
Fruit juices without pulp
Coffee or tea (without milk or nondairy creamer)
Clear broth or bouillon
Plain Jell-O (without added fruits or toppings) Complete all steps below:
STEP 1: Purchase a box of Dulcolax Laxative tablets and two 10oz bottles of Magnesium Citrate STEP 2: Take two Dulcolax tablets at . . . . . o 12:30pm OR o 3:30pm STEP 3: Drink 10oz bottle of Magnesium Citrate at o 1:00pm OR o 4:00pm STEP 4: Take two Dulcolax tablets at . . . . . . . o 4:30pm OR o 7:30pm STEP 5: Drink 10oz bottle of Magnesium Citrate at o 5:00pm OR o 8:00pm HELPFUL HINTS: Stay hydrated. Applying a small amount of lotion or petroleum jelly before each bowel
movement is helpful.
Please do not eat or drink anything, INCLUDING WATER, after midnight.