Long-term therapy may cause electrolyte imbalance and dependence. Lambert and Herman (1996) state that out of the 23 cases reviewed only two resulted in death and one in irreversible brain damage, and that in these cases toxicity was well advanced by the time of diagnosis. This article has been double-blind peer-reviewed. It also recognises that hyperphosphataemia and hypocalcaemia secondary to phosphate enema have been reported in the literature. Phosphate enema (for example Fleet enemas) Mode of action: acts by retaining fluid in bowel osmosis. The MCA was approached for data on reported adverse reactions to phosphate enemas, and sent data covering the period from July 1963 to November 2002. The risks associated with the use of phosphate enemas for treating constipation appear to be: - Rectal injury caused by the enema tip and the damage exacerbated by the phosphate solution; - Phosphate absorption from pooling of the enema due to lack of evacuation of the enema and stool or altered bowel anatomy in the patient; - Hyperphosphataemia in patients who are unable to excrete phosphate adequately, such as those with a degree of renal impairment or reduced renal clearance. All drugs have the potential to induce adverse reactions, which clinicians are urged to report to the Medicines and Healthcare products Regulation Agency (MHRA), formerly the Medicines Control Agency (MCA). MOA = Mechanism of action Phosphate-containing laxatives are not recommended. In addition to its well-known role as a structural component of teeth and bone, phosphorus also serves as a buffer in intracellular and renal tubular fluids, and is an essential element of nucleic acids, phospholipid cell membranes, and phosphoproteins. Sodium phosphate is a saline laxative that is thought to work by increasing fluid in the small intestine. Be ready to tell or show what was Sodium phosphate. The enemas were phosphate, sodium chloride, soap suds, and tap water, and the participants were medical students. When choosing laxatives, a knowledge of the main mechanism of action of laxatives is helpful. Laxatives, Purgatives. Predsol retention enema is a clear, colourless liquid free from haze and substantially free from particulate matter. Can be given via enema or suppository. help if any of these side effects or any other side effects bother you or do not go away: These are not all of the side effects that may occur. Onset of action: 2 to 5 minutes. Advise patient to ↑ fluid intake to a minimum of 1500–2000 mL/day during therapy to prevent dehydration. Do not store in a bathroom. Phosphorus homeostasis Phosphorus has numerous functions in the human body. Sodium is the principal cation of extracellular fluid. In a case report and literature review, Thiele and Zander (2002) discuss prompt and appropriate treatment of enema-induced injuries. Both enemas produced a large stool, so pooling of the enema was not an issue. The mechanism of action is largely osmotic – increased fluid retention in the intestine causes distension which in turn promotes peristalsis and evacuation of the colon. It discusses the use of enema syringes and rubber tubing, a practice that is not used today in enema administration. Very bad kidney and heart problems have rarely happened in people using these products to treat constipation. The first study (Atkin et al, 2000) is a single blind randomised trial into the efficacy and acceptability of an oral laxative versus a self-administered phosphate enema in bowel preparation for a sigmoidoscopy. Find out what health conditions may be a health risk when taken with Phosphate Enema Rectal Put enema tip into the rectum with gentle pressure. pharmacist if you have questions about the best way to throw out drugs. For example, nurses do not know whether constipation is above the splenic flexure without an X-ray, which is unlikely to happen prior to every phosphate enema administered. Introduction. Phosphate enemas contain sodium acid phosphate and sodium phosphate. You may report side effects to the FDA at 1-800-332-1088. Therefore, three of the five circumstances listed in Box 1 are common situations in which nurses may administer a phosphate enema. In a case study by Bell (1990) it was 16 hours from enema administration to the onset of generalised peritonitis. When prepared extemporaneously, the BP states Phosphates Enema BP Formula B consists of sodium dihydrogen phosphate dihydrate 12.8 g, disodium phosphate dodecahydrate 10.24 g, purified water, freshly boiled and cooled, to 128 mL. The dehydration may have caused the constipation but if severe enough could also result in an electrolyte imbalance. For this reason oral administration is more effective than the use of enemas which should, if possible, be retained for 9 hours. This revealed a total of 24 suspected reactions, including neurological, cardiovascular, gastrointestinal, immune system and skin reactions, as well as two fatalities. MECHANISM OF ACTION — Reduces surface tension of the oil-water interface of the stool resulting in enhanced incorporation of water and fat allowing for stool softening. This article reports on the review. Turrell suggested that the phosphate enema solution could have a profound chemical effect on a lacerated area, compounding the injury. If you have any of these health problems: Bowel block, hole in the bowel, or other bowel problems; electrolyte (like sodium, potassium, Most of the time, this happened when people used more of Fleet (sodium phosphates enema) than they were told. Mechanism of action Phosphate enemas are used in people to relieve occasional constipation and for bowel cleansing prior to a colonoscopy.1 Because phosphate enemas are hypertonic, they cause water to move into the colon and increase the water content of the stool, resulting in evacuation of the bowel within five to 10 minutes. Mode of action: acts on contact with large bowel mucosa to produce a soft stool. The paper acknowledges that the applicator on the enema bag can cause injury to the recto-sigmoid colon, and that the hypertonic solution of the enema can exacerbate mucosal necrosis. For best results, stay lying down and hold in the enema until … Mechanism of action Sodium phosphate is thought to work by increasing the amount of solute present in the intestinal lumen thereby creating an osmotic gradient which draws water into the lumen 1. 5.1 Pharmacodynamic Properties. An alternative to phosphate enemas could be macrogols (polyethylene glycol osmotic laxatives). Nurses are expected to deliver care that is based on current evidence (NMC, 2002), yet this literature review has found no evidence to support the use of phosphate enemas. Some OTC laxatives are not recommended for people with specific diseases or conditions (for example, people with diabetes). They offer two case reports, one in which a phosphate enema administered by a health care assistant resulted in pain at the time of administration, followed by rectal bleeding, rectal necrosis, debridement, and eventually a colostomy. If your symptoms or health problems do not get better or if they become worse, call your doctor. There are several alternatives to phosphate enemas, all of which are associated with fewer side-effects and have the potential to act within 15 minutes: For the treatment of faecal impaction, macrogols (polyethylene glycol osmotic laxatives) may be used to prevent non-evacuation of the phosphate solution. However, some precautionary guidelines on the use of phosphate enemas can be offered (Box 2). hours. Dibasic sodium phosphate and monobasic sodium phosphate are poorly absorbed from the gastrointestinal tract and retain water in the lumen of the intestine. Do not use more than 1 dose of Fleet (sodium phosphates enema) in 24 hours. This meant the four enemas the patient received was the equivalent of eight US Fleet enemas. Its laxative action is the result of osmotic imbalance that extracts bound water from stool and pulls it back into the large bowel. You will need to talk about the benefits and risks of using Fleet (sodium phosphates enema) If you are 65 or older, use Fleet (sodium phosphates enema) with care. Samadian (1990) reports a case in which an 84-year-old man was given a phosphate enema with a standard-length tube on two successive days. MECHANISM OF ACTION. Do not take more often than told by the doctor. Sodium phosphate is a saline laxative that is thought to work by increasing fluid in the small intestine. It is also possible that there may be a delay between administration of the enema and the onset of complications such as rectal bleeding, so that a connection is not made between the symptoms and the enema. Phosphate enema (for example Fleet enemas) Positions for using this enema. The common indications for lactulose, macrogol and phosphate enema are. Orally, its onset of action is usually 6—8 hours, and it works in the colon. One company sent three papers - two concerned bowel preparation and one compared different enemas. Call your doctor or get medical It was claimed that as Knobel and Petchenko’s case had taken place in Israel, the product used was a phosphate enema manufactured in Israel, which was double the dose of the US product. Knobel and Petchenko claim that their case demonstrates: - Phosphate enema solutions when given in excess can be life-threatening; - Their use should be restricted not only in children but also in adults with renal failure; - Alternative laxative drugs should be considered to prevent unnecessary complications. XR Barium Enema MOM + Warm prune juice po. Keep all drugs in a safe place. If you have a lot of fluid loss, you may have Do not use more or less of it or use it more often than directed on the package label. 5 Pharmacological Properties. Salt water is the best option for cleansing enemas. Mechanism of Action As a laxative, exerts osmotic effect in the small intestine by drawing water into the lumen of the gut, producing distention and promoting peristalsis and evacuation of the bowel; phosphorous participates in bone deposition, calcium metabolism, utilization of B complex vitamins, and as a buffer in acid-base equilibrium This is a hypertonic solution. The hyperphosphataemia occurred because the patient’s ability to excrete phosphate was impaired due to renal failure. Mechanism of Action Phosphorus is involved in many biochemical functions in the body and significant metabolic and enzyme reactions in almost all organs and tissues; it exerts a modifying influence on the steady state of calcium levels, a buffering effect on acid-base equilibrium, and a primary role in the renal excretion of hydrogen ion Sodium phosphate enema mechanism Download Here Free HealthCareMagic App to Ask a Doctor All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. ‘The energy and organisation on display has been incredible’. This suggests the company is aware of the problems attributed to phosphate enemas but takes the opportunity to offer solutions in this paper. Mechanism of Action As a laxative, exerts osmotic effect in the small intestine by drawing water into the lumen of the gut, producing distention and promoting peristalsis and evacuation of the bowel; phosphorous participates in bone deposition, calcium metabolism, utilization of B complex vitamins, and as a buffer in acid-base equilibrium It is used to clean out the GI (gastrointestinal) tract. Large volume enemas (should be used with caution only after consideration of micro-enemas and suppositories). Keep all drugs out of the reach of children and pets. Mineral oil retards colonic absorption of fecal water and softens the stool. Tell your doctor about the allergy and This activity could increase the water content and … Dehydration and retention of the enema are common in patients who require phosphate enemas, while the existence of renal insufficiency would not necessarily be checked prior to administration. The damage was probably due to the enema nozzle causing a mucosal laceration which, when combined with the hypertonic enema, resulted in necrosis (Bell, 1990). It usually results in a bowel movement after 30 minutes to 6 hours. She was admitted with abdominal pain and vomiting and was known to have had chronic constipation, recurrent faecal impaction, and megacolon. Phosphate-Containing Enemas. It has not been possible to fulfil the aim of the review to establish an evidence base for district nurses in their use of phosphate enemas. The second article looks at the management of constipation in adults (Gattuso and Kamm, 1993), and offers a treatment plan. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Pharmacokinetics These are metabolically inert (Schiller, 2001), have few side-effects, and can be used with patients who have pre-existing renal failure. Mineral oil retention enema Tap water enema Phosphate enema Soapsuds enema — — Fleet — 199–25 0mL once daily per … The enema solution then causes an inflammatory response, which is exacerbated by bacterial invasion. Sodium polystyrene sulfonate (SPS) is a non-absorbed, cation-exchange polymer indicated for the treatment of hyperkalemia. The paper discusses stimulant laxatives, stating that bisacodyl suppositories are an effective and acceptable alternative to phosphate enemas. However, these circumstances present problems for nurses. May cause hyperphosphatemia, hypernatremia, hypocalcemia, hypotension, and acidosis. Goldman (1993) claims that the fact that over two million phosphate enemas are manufactured each year confirms their ‘continuing popularity’. This is not a list of all drugs or health problems that interact with Fleet (sodium phosphates enema). Thiele and Zander suggest that patients who did not feel discomfort suffered injuries above the dentate line, where there is no sensation. An abdominal X-ray showed faecal impaction. Tell all of your health care providers that you take Fleet (sodium phosphates enema). Caroline Davies, MSc, RGN, RM, ONC, DipN, Dip Comm Studies (District Nursing), is district nurse, Rowden Surgery, Chippenham, Wiltshire, and is employed by Kennet and North Wiltshire Primary Care Trust. As part of the investigation into an evidence base for the use of phosphate enemas the two leading manufacturers of the enemas were asked to supply the evidence base for the use of their products. The enema works by drawing water into the large intestine to produce a bowel movement. Septicaemia was diagnosed, and eight days later his rectal and perianal tissues were ulcerated and sloughed, there was destruction of the anterior rectal wall, and a deep cavity extending into the perineum. Mineral oil is an oral and rectal lubricant laxative. Like with many other laxatives, there is a risk of diarrhea.Lactulose and phosphate enema are associated with electrolyte disturbances.Osmotic laxatives should be avoided in patients with intestinal obstruction.Phosphate enema should be used with caution in patients with heart failure or ascites. AVOID retention of enema as increased systemic absorption can cause severe electrolyte disturbances. Most patients to whom community nurses administer enemas are elderly, many are frail and often dehydrated. Mechanism of action. The outcome of this study was that phosphate enemas were preferred as the bowel was prepared in only six-and-a-half minutes, which was thought to be useful in busy clinics with many people waiting for investigation. phosphate) problems; fluid loss (dehydrated); or had stomach or bowel surgery. It is usually inserted when a bowel movement is desired. with your doctor, nurse, pharmacist, or other health care provider. Can be given PO via liquid, capsule, or tablet. Talk with your doctor before you drink alcohol. However, many people have no side effects or only have minor side effects. The action may be delayed for one or two days … Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. It has been suggested, however, that the low incidence of complications may be due to under-reporting (Martin et al, 1987). However, it can be argued that it would be preferable not to risk damage from hypertonic phosphate solution in the first instance, rather than prescribe steroids and antibiotics to address any damage caused. Pietsch et al (1977) defend the use of phosphate enemas and conclude that any form of enema could cause problems. short-term therapy. Do not take other drugs within 2 hours of Fleet (sodium phosphates enema). After this paper was published the vice-president of the Fleet enema company defended the product (Post, 1997). Nir-Paz et al (1999) conclude that the use of sodium phosphate preparations is widespread and results in few complications, but that their use in patients with impaired renal function is a potential hazard.