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Writing the Initial Parenteral Nutrition Order
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Sodium can be added to PN in one of the three forms, sodium chloride, sodium acetate and sodium phosphate. The usual practice is to balance the sodium chloride and sodium acetate equally. The sodium phosphate is generally considered more for its phosphate replacement than for its sodium content. We will address phosphate a little further down.
Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Suppositories may be of the type that will simply soften the stools, or they may have a stimulant effect. Greenstein (2009) recommends that glycerol suppositories are satisfactory and other types offer no advantage. There are microenemas available containing only 5 mL of solution that can act as a colon stimulant. For more vigorous bowel cleansing (e.g. prior to a bowel investigation), a larger phosphate enema may be used. Phosphate enemas work through osmosis – by extracting water from the bowel to draw into faeces, thus increasing the faecal mass (Bowers 2006). Bowers asserts that there is a lack of evidence to support use of phosphate enemas for constipation above other products, but that they are an effective way of clearing the colon prior to flexible sigmoidoscopy. Complications of phosphate enemas are rare but can be serious. People with severe constipation often have other underlying conditions that may make them more at risk of complications. It is important to check the manufacturer’s instructions when administering a phosphate enema. There are a number of contraindications, and the RCN (2019) advises that they may be contraindicated for older or debilitated individuals and people with renal impairment. The systematic review of sodium phosphate enema administration by Mendoza et al. (2007) identified that side effects (mainly water and electrolyte disturbances) were rare, mainly occurring in the very young (under 5 years) or people older than 65 years. Individuals suffering side effects often had conditions such as neurological, gastrointestinal or renal disorders.
Biochemical Methods of Studying Hepatotoxicity
Published in Robert G. Meeks, Steadman D. Harrison, Richard J. Bull, Hepatotoxicology, 2020
Prasada Rao S. Kodavanti, Harihara M. Mehendale
0.18 M Sodium phosphate buffer, pH 7.5: Dissolve 5.4 g monobasic sodium phosphate and 6.39 g dibasic sodium phosphate in a final volume of 250 ml with distilled water. Mix mono- and dibasic solutions appropriately to get pH 7.5 by using a pH meter.
Toxicity of phosphate enemas – an updated review
Published in Clinical Toxicology, 2022
Rosa Hamilton Smith, Michael Eddleston, D. Nicholas Bateman
In the UK and US, sodium phosphate enemas contain osmotically active phosphate. Commonly used preparations include Sodium Acid Phosphate with Sodium Phosphate (Fleet Enema®; dihydrogen phosphate dihydrate 12.8 g with disodium phosphate dodecahydrate 10.24 g, in water to 128 mL; ∼1400 mM with an osmolality of >2200) [1] and Sodium Phosphates Enema (monobasic sodium phosphate 19 g with dibasic sodium phosphate 7 g in water to 118 mL), the amount prescribed varying slightly from product to product. The dose is usually prescribed as a volume and depends on patient age, 2–4 years 25% adult dose (∼30–35 mL); 5–11 years 50% adult dose (∼60–70mL); over 12 years full dose (118–128 mL). The phosphate solution has osmotic action and works by pulling water into the lower bowel, softening and expanding the stool, resulting in a build-up of pressure that triggers peristalsis and allows defaecation to take place, usually within only a few minutes. This rapid expulsion of an enema with the stool results in low exposure of the gut to the high phosphate dose. However, occasionally, the sodium phosphate solution is retained in the gut lumen and then absorbed, which can lead to water and electrolyte imbalances, and resultant clinical consequences [2]. Adverse effects resulting from rapid increases in serum phosphate with resultant changes in calcium and magnesium, or effects from the excess movement of fluid into the bowel lumen from the blood.
CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy – a multicentric validation study
Published in Scandinavian Journal of Gastroenterology, 2022
Rui de Sousa Magalhães, Carolina Chálim Rebelo, Bernardo Sousa-Pinto, José Pereira, Pedro Boal Carvalho, Bruno Rosa, Maria J. Moreira, Maria A. Duarte, José Cotter
Bowel preparation was performed according to our center’s protocol [8–10]. Patients were instructed to have a low-fiber diet and ingest at least 10 glasses of water 2 days before the procedure. On the day before the procedure, a clear liquid diet was prescribed, as well as 1 L of polyethylene glycol solution plus ascorbate followed by 1 L of water between 7 and 9 pm. On the day of the procedure, another 1 L of this solution followed by 1 L of water was ingested (between 6:30 and 8:30 am), and fasting was warranted afterward. Thirty minutes before capsule ingestion, patients were given 100 mg of simethicone and 10 mg of domperidone. At 9 am, patients were instructed to ingest the capsule. One hour later, using the real-time viewing system, capsule progression to the small bowel was confirmed, and 10 mg of domperidone was administered if the capsule was still in the stomach. Thirty minutes later, capsule progression was assessed, and in the case of delayed stomach emptying, endoscopic capsule placement in the small bowel was performed. When the small bowel was reached, a booster of 30 mL of sodium phosphate solution (Fleet Phospho Soda; Casen-Fleet Laboratories, Madrid, Spain) was administered, followed by ingestion of 1 L of water; 3 h later, the second booster of sodium phosphate (15 mL) was administered, plus 500 mL of water. After another 3 h, if the capsule was not excreted, a bisacodyl suppository was given.
Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury
Published in The Journal of Spinal Cord Medicine, 2021
Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Catherine S. Wilson, Mark Korsten
The standard Fleet Enema is a saline laxative that contains monobasic and biphasic sodium phosphate. It draws water into the small intestine, causing distension and peristaltic action, which assists in bowel evacuation.66 No specific parameters for Fleet administration for individuals with SCI were found. Although Fleet Enema packaging instructs that bowel movement can be expected 2 to 5 minutes following administration,164 Stiens et al.66 advise that phosphate enemas have an unpredictable onset. Because of severe adverse reactions within the general population, the U.S. Food and Drug Administration (FDA) strongly supports adherence to the recommended dose of 1 sodium phosphate product per 24 hours.165 The FDA also states that individuals who are taking sodium phosphate products should be well hydrated and have their electrolyte balance and renal function assessed if they are at high risk, vomit, have signs of dehydration, or retain a rectal dose for more than 30 minutes.165