title: Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience.
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.
authors.affiliation: Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Ori
authors.forename: Benaya
authors.initials: B
authors.lastname: Rozen-Zvi
authors.forename: Avry
authors.initials: A
authors.lastname: Chagnac
authors.forename: Michal
authors.initials: M
authors.lastname: Herman
authors.forename: Boris
authors.initials: B
authors.lastname: Zingerman
authors.forename: Eli
authors.initials: E
authors.lastname: Atar
authors.forename: Uzi
authors.initials: U
authors.lastname: Gafter
authors.forename: Asher
authors.initials: A
authors.lastname: Korzets
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000009:adverse effects*; D004733:Enema / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000401:mortality*; D008875:Middle Aged; D010710:Phosphates / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate