A Comparison of the Efficacy of Enema Solutions in Pediatric Emergency Department Patients

Anderson, Julie; Furnival, Ronald A.; Zhang, Lei; Lunos, Scott; Sadiq, Zujaja; Strutt, Jonathan; Kaila, Rahul; Hendrickson, Marissa A.

doi:10.1016/j.jemermed.2019.07.009

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…Other adverse events are mostly minor and include abdominal pain, emesis, and diarrhea [ 66 ]. Some enemas contain a combination of ingredients, for example, an enema consisting of docusate, magnesium citrate, mineral oil, and sodium phosphate [ 67 ].…”

Section: Enemasmentioning

confidence: 99%

“…The efficacy of different enema solutions used in pediatric emergency departments was investigated by a retrospective study in 768 children with constipation with and without underlying anatomical disorders [ 67 ]. The enema solutions included sodium phosphate, pink lady, and soap suds, and the study reported that there was no significant association between stool output (small, medium, or large) and enema solution.…”

Section: Enemasmentioning

confidence: 99%

“…The enema solutions included sodium phosphate, pink lady, and soap suds, and the study reported that there was no significant association between stool output (small, medium, or large) and enema solution. In addition, a low rate of side effects was reported for all enemas, side effects were minor and consisted mostly of abdominal pain and vomiting [ 67 ]. It is worth mentioning that soap suds are widely used in emergency departments; however, little evidence is available supporting their efficacy and safety [ 70 ].…”

Section: Enemasmentioning

confidence: 99%

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An Update of Pharmacological Management in Children with Functional Constipation

et al. 2023

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Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. It is a clinical diagnosis based on the Rome IV criteria. Nonpharmacological treatment involves education, demystification, lifestyle advice, and toilet training. Pharmacological treatment consists of disimpaction, maintenance treatment, and eventually weaning if possible. Polyethylene glycol is considered as the first choice of laxative for both disimpaction and maintenance treatment. Different osmotic laxatives, stimulant laxatives, lubricants, and enemas are available as alternative pharmacological treatment options. Novel drugs are emerging but evidence to support the widespread application of these drugs in the pediatric population is often lacking and more high-quality research is needed in this field. If children remain symptomatic despite optimal pharmacological treatment, botulinum toxin injections in the anal sphincter can be considered as an alternative, more invasive treatment option. This review provides an update on currently available literature concerning the pharmacologic treatment of functional constipation in children.

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Section: Enemasmentioning

confidence: 99%

Section: Enemasmentioning

confidence: 99%

Section: Enemasmentioning

confidence: 99%

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An Update of Pharmacological Management in Children with Functional Constipation

et al. 2023

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“…We identified nine large case series and clinical trials evaluating the effects of phosphate enemas on serum electrolytes or calcium and magnesium published since January 2005 (Table 2). Only one of these was in children, by Anderson et al who retrospectively assessed the efficacy of different enema preparations by case note review in 768 children in a paediatric emergency department [26]. The median age was 6.2 years (IQ range 3.3-10.3 y), enemas used were sodium phosphate, phosphate content not specified (median 59 mL (3.1 mL/kg), n ¼ 396), a docusate, magnesium citrate, mineral oil, and sodium phosphate mixture (286 mL (9.6 mL/kg), n ¼ 198), soap suds (240 mL (7.5 mL/kg), n ¼ 160), and other preparations (n ¼ 14).…”

Section: Observational Studies and Clinical Trials Of Effects On Elec...mentioning

confidence: 99%

Toxicity of phosphate enemas – an updated review

Smith

Eddleston

Bateman

2022

Clinical Toxicology

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Introduction: Enemas containing phosphate are widely prescribed and may cause important adverse effects. A systemic review published in 2007 reported the literature on the adverse effects of phosphate enemas from January 1957 to March 2007 and identified 12 deaths. These were thought due to electrolyte disturbances, heart failure and kidney injury. These data raised concerns about the use of phosphate enemas in routine practice. Newer osmotic-based enema alternatives are now available that do not contain absorbable ions. We sought to review the literature since this review and evaluate the latest data on the toxicity of phosphate-containing enemas. To gain a fuller picture we included case series and larger studies as well as case reports. Objectives: To review the toxicity of phosphate enemas, particularly with respect to acute metabolic consequences and their associated clinical features. To identify risk factors for metabolic toxicity and consider whether phosphate enemas should be relatively contra-indicated in specific patient groups. Methods: A systematic literature review was conducted in PubMed, Google Scholar, and Cochrane Reviews (2005-2021) using the search terms 'phosphate enema or sodium phosphate enema' or 'phosphate-based enema' or (phosphate AND enema) or (Fleet AND enema) or 'sodium phosphate laxatives' or 'sodium phosphate catharsis' or 'sodium phosphate cathartic'. Relevant papers were read, and data were extracted. Results: The searches identified 489 papers of which 25 were relevant: seven papers were case reports or small case series of metabolic abnormalities from the use of phosphate enemas in nine children, six were case reports on 16 adults. Nine papers were large case series or clinical studies that included data on systemic metabolic effects, of varying size from 24 healthy volunteers to a cohort of 70,499 patients. Case reports identified seven adult deaths but none in children. Children most often presented with decreased consciousness (6/9), and tetany (4/9). In adults overall only five cases had clinical features reported, hypotension was seen in four and QT prolongation in two. Treatment was generally symptomatic, with intravenous fluid and calcium salts for electrolyte changes and hypocalcaemia, and vasopressors for severe hypotension. Haemodialysis was used in three children and peritoneal dialysis in one, all of whom survived. In adults, haemodialysis did not prevent death in two of four cases in whom it was used. Common factors underlying toxicity were inappropriately high phosphate dose, or enema retention, both resulting in greater absorption of phosphate. Associated pre-disposing conditions included Hirschsprung disease in children and co-morbidity and renal impairment (2/5) in older adults. Absolute reported changes in serum phosphate or calcium were not accurate indicators of outcome. Larger case series and clinical trials confirm an acute effect of phosphate enemas on serum phosphate, which was related to both dose and retention time. These effects were not seen with non...

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“…The selection of the enema type is based more on physicians’ preferences and local practice patterns than proven differences in efficacy or safety [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

The Risks of Phosphate Enemas in Toddlers: A Life-Threatening Unawareness

Zago,

Occhipinti,

Bramuzzo

et al. 2024

Children

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Background: While oral laxatives represent the first-line treatment of fecal impaction, enemas are frequently used in clinical practice in pediatric emergency departments (PEDs) and by family pediatricians (FPs). Objectives: Phosphate-containing enemas (PcEs) are commonly employed, even causing the risk of rare but lethal toxicity. We investigated pediatricians’ awareness of PcE risks. Methods: We conducted an online survey by sending a multiple-choice questionnaire to the referents of 51 PEDs and 101 FPs. We collected and compared the answers with recommendations reported by the Italian Drug Agency (AIFA) and the available literature about PcE administration. Results: Of the institutions and pediatricians receiving the questionnaire, 23 PEDs (45%) and 63 FP (62.3%) participated in the survey. Of PEDs, 95% and 33.0% of FPs treated fecal impaction with PcE. Moreover, 54% of PEDs and 86.0% of FPs did not provide treatment according to the AIFA recommendations for the daily dose. Conclusions: This study shows limited pediatricians’ awareness of the potential risks related to PcE.

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A Comparison of the Efficacy of Enema Solutions in Pediatric Emergency Department Patients

Cited by 6 publications

References 27 publications

An Update of Pharmacological Management in Children with Functional Constipation

An Update of Pharmacological Management in Children with Functional Constipation

Toxicity of phosphate enemas – an updated review

The Risks of Phosphate Enemas in Toddlers: A Life-Threatening Unawareness

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