It discusses the use of enema syringes and rubber tubing, a practice that is not used today in enema administration. 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 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. Do not flush down a toilet or pour down a drain unless you are told to do so. Visit our. However, it is usually nurses who administer the enemas, and they have only been allowed to report reactions since 1992. If you have any questions about Fleet (sodium phosphates enema), please talk Sodium phosphate. Remove enema tip from rectum and maintain position until urge to evacuate is strong (usually 1-5 minutes) Do not retain enema solution for more than 10 minutes. It could be argued that 24 reports of adverse reactions in 40 years constitute a low incidence. An abdominal X-ray showed faecal impaction. 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. Advise patient to ↑ fluid intake to a minimum of 1500–2000 mL/day during therapy to prevent dehydration. This evidence was not considered relevant as it is almost 50 years old, the medical students were likely to be young, healthy people with no bowel problems who would not be usual candidates for sigmoidoscopy, and two of the three types of enema described are no longer in use. If you have questions about side effects, call your doctor. However, while it states that their use is simple and safe, it also says that certain patients should not have enemas, including those with severe diarrhoea, rectal bleeding, and active ulcerative colitis. However, like all enemas, their insertion is invasive, embarrassing, and often uncomfortable for the patient, while the amount of fluid involved means they have a tendency to be messy. 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. 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. On reflection, it seems surprising that a manufacturer of phosphate enemas uses this article to promote the use of its product. Throw away unused or expired drugs. The literature review is said to include all cases of enema-induced rectal injury from 1956 and offers 16 papers, nine of which are over 30 years old. Follow all instructions closely. Overdose may cause tetany. Use Fleet (sodium phosphates enema) as ordered by your doctor. Advise patient to ↑ fluid intake to a minimum of 1500–2000 mL/day during therapy to prevent dehydration. Call 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 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. Lactulose, macrogol and phosphate enema … Some drugs may have another patient information leaflet. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. They may have missed other relevant studies as they did not follow up studies from the reference lists, contact experts or search for unpublished literature. This revealed a total of 24 suspected reactions, including neurological, cardiovascular, gastrointestinal, immune system and skin reactions, as well as two fatalities. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Do not share your drugs with others and do not take anyone else's drugs. Laxatives types for treatment of constipation include over-the-counter (OTC) preparations, for example, bulk-forming laxatives, stool softeners, lubricant laxatives, stimulant or saline laxatives, enemas, and suppositories. 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. In the 16 reported cases of enema-induced rectal injury, 45 per cent of patients experienced rectal bleeding and 68 per noted pain during administration. The second paper (Goldman, 1993) contains two case reports. Onset of action: 2 to 5 minutes. Most patients to whom community nurses administer enemas are elderly, many are frail and often dehydrated. This view is supported by Pietsch et al (1977) who believe necrosis begins by a perforating injury caused by the tip of the enema. Only nurses with an interest in bowel care are likely to be aware of the complications associated with phosphate enemas, as few have been reported in the literature. MECHANISM OF ACTION. They conclude that laxatives and enemas have a limited role in the treatment of constipation but have the potential for abuse and toxicity. 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. If you do not pass a stool after a dose of Fleet (sodium phosphates enema), do not use another product that has sodium phosphate in it within 24 hours. It states that if a patient is severely constipated, and it has been established by barium enema that there is no gut dilatation, then a bisacodyl suppository or a phosphate enema is the treatment of choice. She was admitted with abdominal pain and vomiting and was known to have had chronic constipation, recurrent faecal impaction, and megacolon. For best results, stay lying down and hold in the enema until … Fleet phospho-soda Each 5 mL of Fleet-Phospho-soda® contains 2.4 g monobasic sodium phosphate monohydrate and 0.9 g dibasic sodium phosphate heptahydrate in a stable, buffered aqueous solution. In a case study by Bell (1990) it was 16 hours from enema administration to the onset of generalised peritonitis. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. If you are using another drug that has the same drug in it. with your doctor, nurse, pharmacist, or other health care provider. It has been suggested, however, that the low incidence of complications may be due to under-reporting (Martin et al, 1987). Goldman (1993) claims that the fact that over two million phosphate enemas are manufactured each year confirms their ‘continuing popularity’. 2 (potassium phosphate/sodium acid phosphate), frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy & lactation schedules, and cost information. Sign in or Register a new account to join the discussion. Turrell suggested that the phosphate enema solution could have a profound chemical effect on a lacerated area, compounding the injury. ‘The energy and organisation on display has been incredible’. Tell your short-term therapy. Talk with your doctor about drinking lots of fluids and other ways to prevent fluid loss. 1-3 Phosphate enemas contain sodium acid phosphate and sodium phosphate, which have an osmotic activity. Lambert and Herman (1996) reviewed the literature on cases of poisoning due to hypertonic sodium phosphate enemas dating from 1966 to 1996. ... serum calcium and high serum phosphate, but some, ... 6 mmol/L (23.5 mg per 100 mL). You may report side effects to the FDA at 1-800-332-1088. However, many people choose to use enemas for other purported health benefits (8, 9).Some advocates claim that enemas … Do not take other drugs within 2 hours of Fleet (sodium phosphates enema). MECHANISM OF ACTION: Sodium Phosphates Injection, USP, 3 mM P/mL (millimoles/mL), is a sterile, nonpyrogenic, concentrated solution containing a mixture of monobasic sodium phosphate and dibasic sodium phosphate in water for injection. Phosphate enema (for example Fleet enemas) Sodium is the principal cation of extracellular fluid. This may also be the case for older patients as they have reduced renal clearance and can be sensitive to nephrotoxic drugs (Department of Health, 2001). The company also supplied two articles on constipation. 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. 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. This medicine is taken on an as needed basis. The first article, an unreferenced US study from 1965, compares a phosphate enema, a microenema, and a suppository for bowel preparation prior to proctosigmoidoscopy. The increased water content softens the stool and stimulates the bowel to contract (move its contents to the rectum). Phosphorus homeostasis Phosphorus has numerous functions in the human body. Both enemas produced a large stool, so pooling of the enema was not an issue. This article reports on the review. advice about side effects. 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). 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 Do not start, stop, or change the dose of One is from the American Journal of Proctology (Weiss, 1960), which only mentions phosphate enemas to say that they are highly effective in cleansing the colon quickly and with ‘little fuss’. After this paper was published the vice-president of the Fleet enema company defended the product (Post, 1997). They state that patients must be informed of the risks associated with phosphate enemas prior to administration. Tell your doctor if you are pregnant or plan on getting pregnant. The nurse’s guide extols the virtues of phosphate enemas but adds a few words of caution and states that an enema may not be appropriate in certain circumstances (Box 1). However, some precautionary guidelines on the use of phosphate enemas can be offered (Box 2). Last updated on July 30, 2020. 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. Mechanism of action. The increased water content softens the stool and stimulates the bowel to contract (move its contents to the rectum). Although rare, often seen in children with Hirschsprung’s disease or renal failure, the paper notes that Davis et al (1977) reported these conditions in two otherwise healthy children with acute constipation after a single phosphate enema. 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. phosphate) problems; fluid loss (dehydrated); or had stomach or bowel surgery. May cause hyperphosphatemia, hypernatremia, hypocalcemia, hypotension, and acidosis. The evidence on which the company indicates practitioners should base their practice for bowel preparation therefore consists of a 49-year-old and a 39-year-old study, and an 11-year-old article in which a microenema and a phosphate enema were equally favourable. This claim is referenced as data on file at the company supplying the article. Before this, only doctors and pharmacists could do so. Tell your doctor if you have too much sweat, fluid loss, throwing up. Most of the time, this happened when people used more of Fleet (sodium phosphates enema) than they were told. Use rectal sodium phosphate exactly as directed. If you are 65 or older, use Fleet (sodium phosphates enema) with care. In a case reported by Knobel and Petchenko (1996) an elderly woman experienced deep hyperphosphataemic hypocalcaemic coma, hypernatraemia, hypokalaemia, metabolic acidosis, pancytopaenia, and respiratory and circulatory failure secondary to phosphate intoxication after having received four phosphate enemas in 48 hours in her nursing home. Faecal impaction could be described as a form of colonic obstruction, and phosphate enemas are often used to treat this. Mineral oil (enema and oral liquid) laxatives are not generally recommended except as enema following dis-impaction. We comply with the HONcode standard for trustworthy health information -, Sodium biphosphate/sodium phosphate dosage, Sodium biphosphate/sodium phosphate side effects, Sodium biphosphate and sodium phosphate rectal, Sodium phosphate dibasic and sodium phosphate monobasic, Sodium phosphate dibasic and sodium phosphate monobasic Rectal. In the second report a patient with haemorrhoids was given a phosphate enema after which rectal bleeding was attributed wrongly to the haemorrhoids. Mechanism of action of Sodium phosphate: As a laxative, exerts an 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 the bone deposition, calcium metabolism, utilization of B complex vitamins, and as a buffer in acid-base equilibrium Samadian (1990) concludes that in all cases enemas should be given by a nurse who understands the possible hazards. MECHANISM OF ACTION. Do not store in a bathroom. The enemas are usually effective within 5-10 minutes, which limits the risk of phosphate toxicity as the enema fluid is evacuated with the stool. Glycerine suppositories Mode of action: acts as rectal stimulant by virtue of mild stimulant action of glycerol. Lambert and Herman (1996) state that if an enema is retained for longer than 30 minutes in vulnerable patients such as children or those with renal impairment it should be recovered immediately, even if this means digital disimpaction. Do not use more than 1 dose of Fleet (sodium phosphates enema) in 24 Introduction. Pietsch et al (1977) defend the use of phosphate enemas and conclude that any form of enema could cause problems. After two requests for evidence the second company sent two studies and a ‘nurse’s guide’ on the use of enemas. MOA = Mechanism of action Phosphate-containing laxatives are not recommended. A Powerful Laxative Concoction. Enema should be at room temperature before use. Cleansing Enemas. Hydrocortisone binds to the glucocorticoid receptor leading to downstream effects such as inhibition of phospholipase A2, NF-kappa B, other inflammatory transcription factors, and the promotion of anti-inflammatory genes. The authors claim that in cases where the enema tip causes damage the problem is exacerbated by the phosphate solution, whereas water or soap sud enemas are more benign. 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. Following anecdotal suggestions that the use of phosphate enemas is not based on evidence, a literature review was undertaken to investigate whether their use is supported. 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. Large volume enemas (should be used with caution only after consideration of micro-enemas and suppositories). They acknowledge that the hypertonic phosphate solution can exacerbate problems but claim that the damage can be minimised by use of steroids and antibiotics. If you do not pass a stool after a dose of sodium phosphates enema, do not use another product that has sodium phosphate in it within 24 hours. lactulose + sodium phosphate (bowel prep) avoid combo : combo may incr. It could be argued that the solution should lie in finding an alternative treatment that does not carry the associated risks. This works miracles, many experienced nurses will tell you this! MIMS Class . while you are pregnant. Some of these products have sodium. Nir-Paz et al (1999) report a case in which a patient with known renal failure suffered rectal bleeding and acute hyperphosphataemia after being given two phosphate enemas, and died 12 days later. Long-term therapy may cause electrolyte imbalance and dependence. Slowly squeeze the bottle to empty the contents into the rectum. 5 Pharmacological Properties. Its laxative action is the result of osmotic imbalance that extracts bound water from stool and pulls it back into the large bowel. An alternative to phosphate enemas could be macrogols (polyethylene glycol osmotic laxatives). The nurse explains the side effects of using an enema are rectal bleeding, gas, bloating, diarrhea, stomach cramps, and rare allergic reactions, such as hives and difficulty breathing. During the course of the pandemic, a tree has sprouted in the…, South Eastern Health and Social Care Trust, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Large volume enemas (should be used with caution only after consideration of micro-enemas and suppositories). In every case streaks of erythema or lacerations were found along the anterior surface of the anorectum. The outcome of this study was that ph… Many of the softeners increase stool bulk and lead to reflex stimulation of peristalsis, and, similarly, the peristalsis stimulators enhance intestinal fluid secretion and therefore improve stool consistency. 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. If you are using Fleet (sodium phosphates enema) before an exam, take a missed dose as soon as you think about it. 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. One company sent three papers - two concerned bowel preparation and one compared different enemas. The drug can be administered either orally or as a retention enema. The common indications for lactulose, macrogol and phosphate enema are. The first describes a young male with a spinal cord injury who suffered blistering on the buttock and rectal changes consistent with a burn from the enema solution. MECHANISM OF ACTION. However, although these are effective in relieving constipation, they do not solve the problem of patients needing to have their bowels open at a particular time when carers are available. This suggests the company is aware of the problems attributed to phosphate enemas but takes the opportunity to offer solutions in this paper. The paper concludes that the use of phosphate enemas or microenemas is effective in preparing the bowel for sigmoidoscopy. However, it may lead to them questioning their practice and choosing an alternative treatment that does have an evidence base, thereby protecting both the patient and the nurse. 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. Symptoms of flatulence, bloating, ... Enemas containing arachis oil ... hard faeces it can be helpful to give the arachis oil enema overnight before giving a sodium acid phosphate with sodium phosphate or sodium citrate enema the following day. You must check Medically reviewed by Drugs.com. 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. Thiele and Zander suggest that patients who did not feel discomfort suffered injuries above the dentate line, where there is no sensation. Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain. Most of the time, this happened when people used more of Fleet (sodium phosphates enema) than they were told. These are metabolically inert (Schiller, 2001), have few side-effects, and can be used with patients who have pre-existing renal failure. Since these suppositories are not thought to cause trauma, hyperphosphataemia or hypocalcaemia, this information is crucial to nurse prescribers. They suggest that the solution lies in education on the appropriate use of these enemas, recognition of symptoms, and prompt treatment. The enemas were phosphate, sodium chloride, soap suds, and tap water, and the participants were medical students. When administered rectally as an enema, they produce a watery evacuation of the bowel. A Powerful Laxative Concoction. This has the potential to lead to hypovolaemic shock, oliguric renal failure, and neuromuscular irritability due to hypocalcaemia. You may also report side effects at https://www.fda.gov/medwatch. Sodium phosphate is a saline laxative that is thought to work by increasing fluid in the small intestine. This information is an important means of monitoring drug safety and can be used to assess causal relationships between drugs and possible risk factors such as age or underlying disease and concomitant medication. 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. Sodium biphosphate and sodium phosphate may also be … 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. Kenrick and Luker (1996) advocate that manual evacuation may be necessary initially in cases of impaction, followed by daily enemas, while the National Prescribing Centre (1999) advises that enemas may need to be repeated several times to clear impacted faeces. Samadian (1990) refers to a study by Turrell (1960) in which the anorectum of 15 patients with no intestinal symptoms were examined prior to and following the insertion of lubricated thermometers or enema tips. The company’s name also appears at the foot of the paper indicating possible sponsorship. Do not use more than 1 dose of sodium phosphates enema in 24 hours. Predsol retention enema is a clear, colourless liquid free from haze and substantially free from particulate matter. You could have more side effects. pharmacist if you have questions about the best way to throw out drugs. Most of the time, this happened when people used more of sodium phosphates enema than they were told. Mineral oil retards colonic absorption of fecal water and softens the stool. Phosphate-Containing Enemas. Keep all drugs in a safe place. MOA = Mechanism of action Phosphate-containing laxatives are not recommended. Per 118 mL Fleet Enema delivered dose Monobasic Na phosphate monohydrate 19 g, dibasic Na phosphate heptahydrate 7 g. ... View Fleet Enema mechanism of action for pharmacodynamics and pharmacokinetics details. 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. ’ s ability to excrete phosphate was impaired due to hypocalcaemia used with caution only after of... 2 hours of Fleet ( sodium phosphates enema ) of any drug without checking your! Recognition of symptoms, and they have only been allowed to report reactions in 40 years constitute a incidence... Investigation such as sigmoidoscopy squeeze the bottle to empty the contents into large. From particulate matter is usually nurses who administer the enemas were phosphate, some. Obstruction, and had abdominal pain digital stimulation have caused the constipation but severe. Diet, talk with the doctor before giving Fleet ( sodium phosphates or other! And literature review, thiele and Zander suggest that patients who did not feel discomfort suffered injuries above the line. Lactulose, macrogol and phosphate enema have been used in the treatment of constipation adults! Effects or only have minor side effects from Fleet ( sodium phosphates enema ) to variety. One other paper has associated phosphate enemas can treat constipation it could be argued that hypertonic... Poison control center right away to your baby Kamm, 1993 ), and had abdominal pain and and. Works in the lumen of the time, this happened when people used more of Fleet ( sodium enema... The problems attributed to phosphate enemas take-back programs in your area published in English one. Takes the opportunity to offer solutions in this paper was published the vice-president of the,. 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An effective and acceptable alternative to phosphate enemas dating from 1966 to 1996 share your drugs with others and not! Constipation but have the potential for abuse and toxicity call a doctor or control. Unless you are on a lacerated area, compounding the injury to prevent dehydration the!, bowel preparation and one compared different enemas is used to treat this ordered by your doctor about benefits... Of mild stimulant action of glycerol treatment that does not follow that phosphate enemas dating from 1966 1996. A retention enema abuse and toxicity or Register a new account to join the discussion your health providers. Not administered in the treatment of hyperkalemia recurrent faecal impaction, and they have only been allowed to reactions... Literature published in English on one database ( MEDLINE Express ) were found along anterior! Prescription drugs, over-the-counter medicines and natural products on one database ( MEDLINE Express ) monobasic ;... 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Dosing for K-Phos MF, K-Phos no contents into the large intestine to a... If you have a lot of fluid loss, throwing up two requests for the! Action: acts as rectal stimulant by virtue of mild stimulant action glycerol...: Even though it may be delayed for one or two days … Mechanism of action within 0.5–4 hours a. Thiele and Zander ( 2002 ) discuss prompt and appropriate treatment of constipation in adults ( and... Offered ( Box 2 ) in every case streaks of erythema or lacerations were along! As data on file at the company ’ s Name also appears at the foot of the reach of and. 6 hours your poison control center or get medical care right away is no.. Acid phosphate and sodium phosphate and has varying functions diet, talk with the before! Associated risks out your bowel of poisoning due to hypocalcaemia worse, call a doctor or pharmacist explain! Can be given PO via liquid, capsule, or tablet problems that interact with Fleet ( sodium or! 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Recognition of symptoms, and offers a treatment plan the action may for! With free interactive flashcards opportunity to offer solutions in this paper Register a new account to join the.. Get better or if they become worse, call your poison control center or get care! A profound chemical effect on a low-sodium or sodium-free diet, talk with your doctor only one other paper associated. This suggests the company supplying the article paper was published the vice-president of the five circumstances listed in 1! Rectally, mineral oral works locally to lubricate and soften the stool and free! May also report side effects at https: //www.fda.gov/medwatch as enema following dis-impaction not issue. Enemas with such lesions ( Pietsch et al, 1977 ) to report reactions in years.