Fleet enema side effects
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Fleet Enema Side Effects: A Comprehensive Overview
Introduction to Fleet Enema Side Effects
Fleet enemas, commonly used for bowel cleansing, can lead to various side effects, some of which can be severe. This article synthesizes research findings on the adverse effects associated with Fleet enemas, focusing on electrolyte imbalances, gastrointestinal complications, and other systemic reactions.
Electrolyte Imbalances and Metabolic Disturbances
Hyperphosphatemia and Hypocalcemia
One of the most frequently reported side effects of Fleet enemas is hyperphosphatemia, an elevated level of phosphate in the blood, often accompanied by hypocalcemia, a decrease in calcium levels. These imbalances can lead to severe complications such as seizures and cardiac issues. For instance, a case study of a 4-year-old girl who received two Fleet pediatric enemas reported significant electrolyte disturbances, including a phosphate level of 23 mg/dL and a calcium level of 3.3 mg/dL, leading to a generalized seizure2. Similar findings were observed in a 5-month-old child who developed shock, hyperphosphatemia, hypocalcemia, and acidosis after being administered an adult Fleet enema1.
Acidosis and Hypernatremia
Fleet enemas can also cause metabolic acidosis and hypernatremia (elevated sodium levels). In the case of a 33-year-old spinal cord injury patient, the administration of a Fleet enema led to autonomic dysreflexia, characterized by a significant rise in blood pressure and subsequent seizure, along with elevated phosphate and sodium levels4. Another study highlighted that hypertonic sodium phosphate enemas could result in severe toxicity even in patients without predisposing risk factors2.
Gastrointestinal Complications
Perforation and Ileus
Gastrointestinal perforation is a serious but preventable complication associated with Fleet enemas. A study evaluating the outcomes of cleansing enemas for acute constipation found that the use of Fleet enemas was linked to a higher rate of perforation and mortality compared to other enema types3. Additionally, a case of a 7-year-old girl with phenylketonuria reported ileus and intra-abdominal hypertension following the use of a phosphate-containing enema, further complicating her condition7.
Rectal Mucosa Changes
Fleet enemas can also cause morphological changes in the rectal mucosa. A study involving 10 normal subjects found that Fleet enemas and bisacodyl enemas caused sloughing of the surface epithelium and other microscopic changes, which could mislead proctologists and pathologists during examinations8.
Systemic Reactions
Autonomic Dysreflexia
In patients with spinal cord injuries, Fleet enemas can trigger autonomic dysreflexia, a potentially life-threatening condition. This was evidenced in a case where a spinal cord injured patient experienced severe hypertension, headache, and a seizure following the administration of a Fleet enema4.
Seizures
Seizures are another severe side effect linked to the use of Fleet enemas, primarily due to the resultant electrolyte imbalances. Multiple case reports have documented seizures in both pediatric and adult patients following the administration of these enemas2 4.
Conclusion
Fleet enemas, while effective for bowel cleansing, carry significant risks of severe side effects, including electrolyte imbalances, gastrointestinal complications, and systemic reactions. These findings underscore the importance of cautious use, especially in vulnerable populations such as children and patients with pre-existing conditions. Proper guidelines and careful monitoring are essential to mitigate these risks and ensure patient safety.
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Most relevant research papers on this topic
Severe hyperphosphatemia, hypocalcemia, acidosis, and shock in a 5-month-old child following the administration of an adult Fleet enema.
Injudicious use of adult Fleet enema in children can result in life-threatening events, such as shock, hyperphosphatemia, hypocalcemia, and acidosis.
Case ReportSevere Hyperphosphatemia and Hypocalcemia Following the Rectal Administration of a Phosphate-Containing Fleet® Pediatric Enema
Rectal administration of hypertonic phosphate enemas can cause severe toxicity, even in patients without predisposing risk factors.
Case ReportPerforation and mortality after cleansing enema for acute constipation are not rare but are preventable
Enema for acute constipation treatment can cause serious adverse events, especially in the elderly, and guidelines for enema administration are urgently needed.
Observational Study
Rigorous JournalFleet Enema-Induced Autonomic Dysreflexia in a Spinal Cord Injured Patient
Fleet enema use in spinal cord injured patients can cause autonomic dysreflexia and electrolyte imbalances, leading to seizures and complications.
Case ReportSerum electrolyte, mineral, and blood pH changes after phosphate enema, water enema, and electrolyte lavage solution enema for flexible sigmoidoscopy.
Fleet enema has better cleansing efficacy than water and Golytely, but not Golytely, and increases serum phosphorus levels, but most patients remain within normal range.
RCTComplications of Fleet® enema administration and suggested guidelines for use in the pediatric emergency department
This study developed guidelines for the safe and effective use of hypertonic sodium phosphate enema solutions in pediatric emergency departments to treat acute constipation.
Systematic ReviewIleus and Intra-Abdominal Hypertension due to Phosphate- Containing Enema
Intra-abdominal pressure measurements are useful in clinical follow-up for patients with progressive abdominal distention due to phosphate enema use.
Case ReportHuman rectal mucosa: proctoscopic and morphological changes caused by laxatives.
Laxatives Fleet's enema and bisacodyl may alter normal rectal mucosa, potentially misguiding proctologists and pathologists.
RCT
Highly CitedColon Cleanout Preparations in Children and Adolescents
GoLYTELY is the most effective and least side effect-causing colon cleanser for children and adolescents undergoing colonoscopy.
Observational StudySerum Electrolyte Shifts Following Administration of Sodium Phosphates Enema
Transient hyperphosphatemia following the use of sodium phosphates enemas correlates with retention time but not with dose, with Enema Casen causing greater serum sodium concentration than Fleet Enema.
Non-RCT