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.)

• Water

• Fruit juices without pulp

• Sports drinks

• Soft drinks

• Coffee or tea (without milk or nondairy creamer)

• Clear broth or bouillon

• Iced Popsicle

• 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.