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.
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