Yerkes E B, Rink R C, King S, Cain M P, Kaefer M, Casale A J
Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Urol. 2001 Oct;166(4):1476-8.
The Malone antegrade continence enema provides independence and improved quality of life in patients with fecal incontinence or intractable constipation. However, isolated reports of fatal hypernatremia after irrigation with normal saline have raised safety concerns about frequent colonic irrigation in children. Significant electrolyte abnormalities have also been reported with hypertonic phosphate and high colonic tap water enemas. Because our patients routinely use tap water for Malone antegrade continence enema irrigations, we examined the safety profile of this practice
In the last 3.5 years 71 patients at our institution have used antegrade tap water enemas for managing fecal incontinence or intractable constipation. Standard serum electrolytes were measured
We obtained 101 sets of serum electrolyte measurements in 71 patients at a mean of 8.4 months postoperatively (range 1 to 33). A girl who presented with severe hyponatremia and hypochloremia had not used the Malone antegrade continence enema for several days. The most interesting finding was significantly elevated sodium and chloride in 1 case 6 weeks after surgery that was associated with tap water treated with a home softening system. Electrolytes reverted to normal 1 week after using untreated tap water
We did not detect significant hyponatremia or hypochloremia in any patient using tap water for Malone antegrade continence enema irrigation. Although dangerous electrolyte abnormalities are rare, potential morbidity in those cases warrants periodic evaluation. Due to the elevated sodium content in softened tap water families should be alerted to use untreated tap water for preparing enemas.
马龙顺行性可控灌肠法为大便失禁或顽固性便秘患者提供了独立性并改善了生活质量。然而，关于用生理盐水灌肠后发生致命性高钠血症的个别报道引发了对儿童频繁结肠灌洗安全性的担忧。也有报道称高渗磷酸盐灌肠剂和高位结肠自来水灌肠剂会导致显著的电解质异常。由于我们的患者常规使用自来水进行马龙顺行性可控灌肠，我们对这种做法的安全性进行了研究。
在过去3.5年里，我们机构的71例患者使用顺行性自来水灌肠来治疗大便失禁或顽固性便秘。检测了标准血清电解质。
我们对71例患者进行了101次血清电解质检测，平均术后8.4个月（范围1至33个月）。一名出现严重低钠血症和低氯血症的女孩已有数天未使用马龙顺行性可控灌肠法。最有趣的发现是1例患者在术后6周钠和氯显著升高，这与经家用软化系统处理的自来水有关。使用未处理的自来水1周后电解质恢复正常。
我们未在任何使用自来水进行马龙顺行性可控灌肠的患者中检测到显著的低钠血症或低氯血症。尽管危险的电解质异常很少见，但这些病例中的潜在发病率值得定期评估。由于软化自来水中钠含量升高，应提醒家庭使用未处理的自来水来配制灌肠剂。
