Author Affiliations: Departments of Nephrology and Hypertension (Drs Ori, Rozen-Zvi, Chagnac, Herman, Zingerman, Gafter, and Korzets) and Diagnostic Radiology (Dr Atar) Rabin Medical Center, Hasharon Hospital, Petah-Tikva, Israel; and Sackler Medical School, Tel-Aviv University (Drs Ori, Rozen-Zvi, Chagnac, Herman, Zingerman, Atar, Gafter, and Korzets).
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.
Ori Y, Rozen-Zvi B, Chagnac A, Herman M, Zingerman B, Atar E, Gafter U, Korzets A. Fatalities and Severe Metabolic Disorders Associated With the Use of Sodium Phosphate EnemasA Single Center's Experience. Arch Intern Med. 2012;172(3):263-265. doi:10.1001/archinternmed.2011.694