Fleets enema

[tartay0211RN]

I was wondering if anyone out there has had this issue before. I have a pt with bowel prep for a colonoscopy. She is an adult size teenager, the MD does not want to order more golytly even though she has not gotten a full does, she has however ordered fleets enemas PRN, she has already gotten 4. I am concerned because the little bit of info I can find says not more than one in a day. Has anyone else seen this or know if this is safe to keep giving them to her?

[justiceforjoy]

I remember being told no more than two per day "in the real world", because it can encourage an electrolyte imbalance, and add onto that: discomfort caused by the irritation of the mucous membrane...

I think that doctor should give you a little more to work with.

[NRSKarenRN, BSN, RN]

adult size teenagers normally do not undergo colonoscopy unless they have/suspected to have gi disease. what was the reason teenager did not get full dose of golytely?

anyone undergoing bowel prep for colonoscopy is at risk for electrolyte imbalances. administering 4 fleets is introducing too much phosphate into gi tract. better option if person unable to tolerate entire prep contacting pcp for advice, possibly request tape h20 enema.

fleets precautions include: do not use if

• if you are on a sodium-restricted diet or have a history of stomach or bowel problems
  
• if you have appendicitis, liver or kidney problems, high blood pressure, low parathyroid function, bone problems (eg, osteomalacia), muscle problems (eg, rhabdomyolysis), pancreas problems, a kidney or bladder infection, kidney stones, electrolyte problems (eg, low blood calcium), a colostomy, nausea, vomiting, stomach pain, or a sudden change in bowel movements lasting longer than 2 weeks
  

how to use include: do not use more than 1 enema in 24 hours.

http://www.drugs.com/cdi/fleet-enema.html

see fda warning: stronger warnings for bowel cleansing agents

fda believes that oral sodium phosphate products should be available only by prescription when they are used for bowel cleansing. because of this, c.b. fleet company has voluntarily recalled the company's oral sodium phosphate products sold over the counter, (fleet phospho-soda and fleet ez-prep) and has advised healthcare professionals not to instruct patients to use these products for bowel cleansing. unico holdings, inc. is also recalling its otc oral sodium phosphate products sold for bowel cleansing.

health professionals should use caution when prescribing visicol or osmoprep for patients who may be at higher risk of kidney injury. this includes those over aged 55, or those who have kidney disease, bowel obstruction, active colitis, or are dehydrated. it also includes patients taking drugs that affect renal perfusion or function such as diuretics, ace inhibitors, angiotensin receptor blockers (arbs) and possibly nsaids.

prescribers should instruct patients about how to prepare for their procedures, and tell them to avoid dehydration by drinking enough clear liquids before, during and after bowel preparation. they should also tell patients to be alert for symptoms of acute kidney injury, including malaise, lethargy, drowsiness, decreased urine volume and swelling of the ankles, feet and legs.

medscape: bowel preparation before colonoscopy: risky business for the kidney?

osmotic laxative