This study examines the hypothesis that whole gut irrigation with polyethylene glycol-electrolyte gavage solution (PEG-ELS) increases intravascular volume. Seventeen patients drank 6 to 8 liters of PEG-ELS in preparation for elective colonoscopy. The patients were weighed and serum electrolytes, albumin, hematocrit, blood urea nitrogen, and creatinine were obtained prior to the gavage and 8 hr following gavage. Plasma volume was measured before and after gavage using an isotope dilution technique involving 125I-human serum albumin. No patients developed symptoms of intravascular volume excess or depletion following gavage. There was no significant change in body weight, serum sodium, chloride, potassium, bicarbonate, blood urea nitrogen, or creatinine following gavage with PEG-ELS. When measured by the isotope dilution technique, the mean plasma volume increased from 3174 +/- 117 ml before gavage to 3365 +/- 160 ml following gavage (P = 0.03). This represented a mean percentage change in plasma volume of 5.88 +/- 2.4%. The percentage change in plasma volume associated with gavage ranged from -9.8 to +29.8%. This data supports the hypothesis that gavage with polyethylene glycol-electrolyte solution is associated with an increase in plasma volume. Although in most patients the increase in plasma volume is minimal, there is significant variability in this response, with some patients experiencing substantial increases in plasma volume.