Information about the use of Fleet enemas in children

Information about the use of Fleet enemas in children PSA #1: Both the adult and pediatric Fleet enemas that are sold OTC and are available to order in Epic contain phosphate. There is a misconception amongst many providers in the hospital that the pediatric Fleet is just saline and glycerin – this is not true PSA #2: Phosphate enemas can cause serious injury to patients with underlying renal disease, severe dehydration, and hyperphosphatemia. I know that all of you know this, but I have been asked to state it! PSA #3: There is essentially a black box warning from the FDA that states phosphate enemas should not be used in children under the age of 2. The reason listed is “risk of severe dehydration and serum electrolyte abnormalities leading to serious complications such as acute kidney injury, arrhythmias, and death” So in response to these issues, you will see a few changes in Epic: 1. There will be a hard stop for ordering a phosphate based Fleet enema in children <2 years of age. You simply will not be able to order this in the inpatient setting and you will be given a suggestion to consider something else. Pedia-Lax enemas are OK in this age group as they are simply glycerin 2. In patients over the age of 2, if the patient has a creatinine or phosphate level in the system and they are abnormal, a warning/best practice alert will pop up in Epic warning of using phosphate based enemas in this population and offering alternative selections. Unfortunately due to limitations in Epic, it will not raise an alert if no electrolytes are in the system. 3. The pharmacy will be working with the Epic team to make it more clear that adult and pediatric Fleet enemas contain phosphate by putting that into the product name as currently they just pop up as “adult Fleet enema” and “pediatric Fleet enema” and don’t indicate the presence of phosphate Other enema options to consider in children: Pedia Lax enemas (packaging says “liquid glycerin suppositories”), which contain 4 mL of liquid glycerin are easy and safe to use in infants and small children. These do not contain any phosphate so despite the label saying age 2+, we have safely used these in infants for years. This should be your first line agent if enema is needed in the younger age group Docusate enema (EnemeezÒ) contains 238 mg of docusate in a 5mL liquid vehicle. This also does not contain phosphate and can be helpful in older children but not infants Saline and glycerin (or soap) enemas – these can be mixed and administered using a variety of different methods including a Foley catheter, emptied Fleet enema container, etc. If you are considering this type of enema, please discuss with attending for further direction