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. 2012 Feb 13;172(3):263-5.
doi: 10.1001/archinternmed.2011.694.

Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience

Yaacov Ori  1 , Benaya Rozen-Zvi, Avry Chagnac, Michal Herman, Boris Zingerman, Eli Atar, Uzi Gafter, Asher Korzets
Affiliations

Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience

Yaacov Ori et al. Arch Intern Med. .

Abstract

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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