Title: Avoid sodium phosphate enemas in renal dysfunction<br/>Author: Jill Logan<br/><a href='mailto:1765'>[Click to email author]</a><hr/><p>
<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Numerous case reports exist of severe metabolic disorders associated with sodium phosphate (Fleet) enemas in both pediatric and renal dysfunction patients. Severe cases have necessitated</span><span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;"> intubation, coma, and have even resulted in death.</span></p>
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<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Electrolyte abnormalities include:</span></p>
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<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Hyperphosphatemia</span></li>
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<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Hypernatremia</span></li>
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<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Hypocalcemia</span></li>
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<span style="font-family: Arial; font-size: 9pt; white-space: pre-wrap;">Hypokalemia </span></li>
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<span style="font-size: 9pt; font-family: Arial; white-space: pre-wrap;">Alternative agents to treat constipation are recommended in patients with renal dysfunction and dialysis patients. </span></p>
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<fieldset><legend>References</legend>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; vertical-align: baseline; white-space: pre-wrap;">Sadaba B, Azana J, Campanero M, Garcia-Quetglas E, Munoz MJ, Marco S. Effects of a 250-mL enema containing sodium phosphate on electrolyte concentrations in healthy volunteers: An open-label, randomized, controlled, two-period, crossover clinical trial. Curr Ther Res Clin Exp. 2006;67:334-49.</span></span></p>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap;">Ori Y, Rozen-Zvi B, Chagnac A, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas. Arch Intern Med. 2012;172:263-5.</span></span></p>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap;">Spalding EM, Chamney PW, Farrington K. Phosphate kinetics during hemodialysis: evidence for biphasic regulation. Kidney Int. 2002;61(2):655-67.</span></span></p>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap;">Backnell B, Smoyer WE, O’Brien NF. Hemodialysis for near-fatal sodium phosphate toxicity in a child receiving sodium phosphate enemas. Pediatr Emerg Care. 2014;30:814-7.</span></span></p>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap;">Knobel B, Petchenko P. Hyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (Fleet) enema intoxication. J Clin Gastroenterol. 1996;23(3):217-9.</span></span></p>
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<span id="docs-internal-guid-fa2aa26f-da51-e9e0-79a5-47c705ee312b"><span style="font-size: 9pt; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap;">Ramirez JA, Emmett M, White MG, et al. The absorption of dietary phosphate and calcium in hemodialysis patients. Kidney Int. 1986;30:753-9.</span></span></p>
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