Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience

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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cathartics / adverse effects*
  • Enema / adverse effects*
  • Female
  • Humans
  • Male
  • Metabolic Diseases / chemically induced*
  • Metabolic Diseases / mortality*
  • Middle Aged
  • Phosphates / adverse effects*
  • Retrospective Studies
  • Severity of Illness Index


  • Cathartics
  • Phosphates
  • sodium phosphate