Meeting personal needs: elimination
Nicola Neale, Joanne Sale in 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.
The Treatment of the Special Forms of Mental Disease
Francis X. Dercum in Rest, Suggestion, 2019
In the second category of drugs, we have those whose action is directed to the condition of the digestive tract, of the kidneys, or of the heart and general circulation. As already stated, there is almost always present a gastric catarrh, and this must be taken into consideration not only in the diet, but also in the medicines prescribed. Silver nitrate, one-fourth grain, in pill, with onefourth grain extract of hyoscyamus, administered three times daily, half an hour or twenty minutes before meals, has, as a rule, a very happy action. At times lavage is necessary, though except in severe cases, this need not be continued very long. Sometimes the morning nausea and vomiting of chronic alcoholism are troublesome, but usually they readily subside. Occasionally, a course of divided doses of calomel, at other times of sodium phosphate, is of value. Small doses of other saline laxatives may likewise be employed. A little later the fluid extract of cascara can be given, just as in the rest treatment of neurasthenia.
Flexible endoscopy
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Generally, oral bowel preparations can be divided into three types. Isosmotic preparations (Golytely®, Glycoprep®, Colyte®, and Nulytely®) usually contain polyethylene glycol (PEG) and are osmotically balanced, high volume, nonabsorbable, and non-fermentable electrolyte solutions. They cleanse the colon by the mechanical effect of large volume lavage. The conventional dose is 3–4 L given as divided doses over a period of some hours. They may also be administered via a nasogastric tube at a rate of 20–30 mL/min. In the case of afternoon lists, it may be preferable to institute a split-dose regimen the afternoon before and early on the morning of the procedure. Low volume PEG solutions are available, combined with stimulant laxatives or ascorbic acid (Halflytely®, Moviprep®).Hyperosmotic preparations draw water into the bowel lumen which stimulates peristalsis and evacuation. Although small volume, these preparations can cause significant fluid and electrolyte shifts. Sodium phosphate (Fleet Phospho-Soda®, Osmoprep®, Fleet®) and sodium sulfate (Picoprep®) preparations are available.Stimulant laxatives include senna, an anthracene derivative, which stimulates colonic peristalsis. Bisacodyl is a diphenylmethane derivative which is poorly absorbed in the small intestine, but following hydrolysis by endogenous estersases its metabolites stimulate colonic motility.
The Effects of Sodium Phosphate Supplementation on Physiological Responses to Submaximal Exercise and 20 km Cycling Time-Trial Performance
Published in Journal of Dietary Supplements, 2019
Jack Alexander Brown, Mark Glaister
Sodium phosphate (SP) is a legal nutritional supplement that has been suggested to improve athletic performance (Currell et al., 2012). Several mechanisms have been proposed to explain this potential ergogenic effect, including an increase in resting erythrocyte 2,3-diphosphoglycerate (2,3-DPG) concentration (promoting oxygen offloading at the muscle via a reduction in oxyhemoglobin affinity) (Bremner, Bubb, Kemp, Trenell, & Thompson, 2002; Cade et al., 1984), an enhancement of myocardial contractility (Kreider et al., 1992), an increase in extracellular hydrogen phosphate (HPO4−) concentration (facilitating hydrogen ion buffering) (Buck, Guelfi, Dawson, McNaughton, & Wallman, 2015; Kopec, Dawson, Buck, & Wallman, 2016), and an increase in the activity of various oxidative enzymes, such as phosphofructokinase and glyceraldehyde 3-phosphate dehydrogenase (Buck, Wallman, Dawson, & Guelfi, 2013).
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.
The relationship between the Hammett acidity and the decomposition of cefotaxime sodium in the solid state
Published in Drug Development and Industrial Pharmacy, 2020
Bashar M. Altaani, Khouloud A. Alkhamis, Shaima’a Abu Baker, Razan Haddad
Solutions containing lactose monohydrate (5% w/v) and phosphate buffer (0.05 M) were prepared. In the case of acidity measurements, thymol blue was added as an indicator and case of kinetic studies cefotaxime sodium (0.01% w/v) was added as a model drug. The ionic strength of the prepared solutions was adjusted using sodium chloride. The phosphate buffer solutions were prepared using different weight ratios of sodium phosphate tribasic and dibasic to obtain solutions with different pH values (9.81–10.68). The effect of ionic strength was also evaluated by preparing a solution (pH = 9.81) without the addition of sodium chloride; lower ionic strength. The pH of all solutions was measured using a calibrated pH meter (WTW 720 GmbH, Germany). The prepared solutions were then lyophilized using a freeze dryer (Labconco corporation, Missouri, USA) according to an established procedure that was previously described [2–3].
Related Knowledge Centers
- Colonoscopy
- Constipation
- Emulsion
- Phosphate
- Polyphosphate
- Sodium
- Salt
- Ion
- Thickening Agent
- Phosphate Nephropathy