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Clinical Observation |

Fatalities and Severe Metabolic Disorders Associated With the Use of Sodium Phosphate Enemas:  A Single Center's Experience

Yaacov Ori, MD; Benaya Rozen-Zvi, MD; Avry Chagnac, MD; Michal Herman, MD; Boris Zingerman, MD; Eli Atar, MD; Uzi Gafter, MD, PhD; Asher Korzets, MBBS
Arch Intern Med. 2012;172(3):263-265. doi:10.1001/archinternmed.2011.694.
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We report our experience with severe complications of sodium phosphate enemas. Eleven elderly patients received Fleet enemas for constipation. Three patients received 500 to 798 mL, and 8 received a standard 250-mL dose. Most presented within 24 hours with hypotension and volume depletion, extreme hyperphosphatemia (phosphorus level, 5.3-45.0 mg/dL), and severe hypocalcemia (calcium level, 2.0-8.7 mg/dL). Hypernatremia and hypokalemia were seen in most patients. Acute renal failure was present in all patients. Two patients required urgent hemodialysis. Five patients died (45%). One patient was autopsied. Calcium-phosphate deposition within the renal tubular lumens was found. Following an educational campaign, the use of Fleet enemas was reduced in our hospital by 96%. Sodium phosphate enemas, even in standard doses, may lead to severe metabolic disorders associated with a high mortality and morbidity. Their use should be limited to low-risk patients only.

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