Ori Yaacov, Rozen-Zvi Benaya, Chagnac Avry, Herman Michal, Zingerman Boris, Atar Eli, Gafter Uzi, Korzets Asher
Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel.
Arch Intern Med. 2012 Feb 13;172(3):263-5. doi: 10.1001/archinternmed.2011.694.
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.
我们报告了使用磷酸钠灌肠剂导致严重并发症的经验。11名老年患者因便秘接受了弗利特灌肠剂治疗。3名患者接受了500至798毫升的剂量，8名患者接受了标准的250毫升剂量。大多数患者在24小时内出现低血压和容量耗竭、极度高磷血症（磷水平为5.3 - 45.0毫克/分升）以及严重低钙血症（钙水平为2.0 - 8.7毫克/分升）。大多数患者出现高钠血症和低钾血症。所有患者均出现急性肾衰竭。2名患者需要紧急血液透析。5名患者死亡（45%）。对1名患者进行了尸检，发现肾小管腔内有磷酸钙沉积。经过一次宣传活动后，我院弗利特灌肠剂的使用量减少了96%。磷酸钠灌肠剂，即使是标准剂量，也可能导致严重的代谢紊乱，伴有高死亡率和发病率。其使用应仅限于低风险患者。
