Enemas administration

Breen KJ, Bryant RE, I evinson JD, Schem-ker S Neomycin absorption in man Studies of oral and enema administration and effect of intestinal ulceration. Ann Intern Med 1972 76 211-218. 

Lie on left side during enema administration (to facilitate migration into the sigmoid colon)... 

Brockbank, W. The ancient art of enema administration. In Ancient Therapeutic Arts The Fitzpatrick Lectures Delivered in 1950 and 1951 at the Royal College of Physicians, William Heinemann Medical Books, Ltd. London, 1954. 

Pitcher DE, Ford RS, Nelson MT, Dickinson WE. Fatal hypocalcemic, hyperphosphatemic, metabolic acidosis following sequential sodium phosphate-based enema administration. Gastrointest Endosc 1997 46(3) 266-8. 

A five-year-old boy weighing 20 kg presented with severe constipation. He was treated with two paediatric-sized phosphate enemas. Approximately 20 min after enema administration, the boy became increasingly lethargic and complained of dizziness. Laboratory tests revealed marked elevation of serum phosphate and decreased calcium levels. This condition was managed with intravenous fluids and calcium gluconate. Normalisation of serum phosphate and calcium levels occurred within 5 h [75 ]. 

Magnesium administration (IV, enteral, and enemas) ° Milk-alkali syndrome... 

Treatment of distal intestinal obstruction syndrome (DIOS) consists of oral or nasogastric administration of polyethylene glycol electrolyte (PEG) solutions. Enemas may also be used to facilitate stool clearance. IV fluids are often required to correct dehydration due to vomiting or decreased oral intake. Re-evaluation of enzyme compliance and dosing is essential to prevent further episodes. Patients with recurrent symptoms may require daily PEG administration (Miralax ).5 Severe presentations of DIOS or initial meconium ileus may require surgical resection. 

Rapid transit through this region suggests that the area is empty of colonic contents most of the time, and so the opportunity for topical treatment is consequently limited. If the exposure to a drug such as mesalazine is calculated on the basis of these data, the results show that treatment is probably inadequate. For example, the dose per day is approximately 3 g (800-1200 mg, t.d.s.), and so in active disease the effective dose would be about 300 mg on the basis of this regimen. Doses of 500-1000 mg are often given as a enema, but these doses are more effectively delivered and not sequestered within a viscous, partially dehydrated stool, as would be the case following oral administration. 

Tap-water enemas may be used to treat simple constipation. The administration of 200 mL of water by enema to an adult often results in a bowel movement within 1.5 hours. Soapsuds are no longer recommended for use in enemas because their use may result in proctitis or colitis. 

Rectal Avoids problems of stability in gastrointestinal tract No first-pass metabolism Useful if oral administration is not possible Unpopular Inconvenient Erratic absorption Irritation Suppositories, enemas (solutions, suspensions, emulsions), foams, ointments, creams... 

Rectal Administer to adults during impending coma or coma stage of portal-systemic encephalopathy when the danger of aspiration exists or when endoscopic or intubation procedures interfere with oral administration. The goal of treatment is reversal of the coma stage so the patient can take oral medication. Reversal of coma may occur within 2 hours of the first enema. Start recommended oral doses before enema is stopped entirely. 

Prednisone, which in the body is converted to the active form prednisolone, is the most widely used corticosteroid. Maximal activity occurs mostly within 1-2 hours after oral administration, and the effects last up to 36 hours. For patients with colitis localized in the lower part of the colon prednisolone sodium phosphate is formulated for rectal administration as an enema. 

Drugs are administrated by intravenous routes or ex-travascular routes including oral, sublingual, subcutaneous, intramuscular, rectal (by enema or suppository), and transdermal. Available dosage forms include suspensions, immediate-release capsules or tablets, sustained-release capsules or tablets, and enteric-coated capsules or tablets that resist dissolution in the acidic pfi of the stomach. 

Administration of drug in the form of liquid into the rectum is called enema, which may be soap water or glycerine-vegetable oil. It is used to remove the faecal matter and flatus and is used in constipation. Certain drugs are administered rectally for producing systemic effects also (e.g. aminophylline, indomethacin, paraldehyde etc.). 

Enema are solution, suspension or emulsion (oil/water type) of medicament intended for rectal administration. 

Rectal administration The drug is also administered rectally in the form of suppositories and enema preparations which are absorbed from the colon. 

Hydrocortisone enemas, foam, or suppositories are used to maximize colonic tissue effects and minimize systemic absorption via topical treatment of active inflammatory bowel disease in the rectum and sigmoid colon. Absorption of hydrocortisone is reduced with rectal administration, although 15-30% of the administered dosage is still... 

Table 10.1 Dog colon tissue biopsy concentrations of intact ISIS 2302 oligonucleotide at 3 and 24 h after single-dose retention enema (10 mg/kg) or intravenous (dosage indicated) administrations.

One death in an adult female due to acute intravasation of barium sulfate during a barium enema was found in the literature. Direct entry of barium sulfate into the circulatory system apparently resulted in cardiorespiratory failure (Cove and Snyder 1974). Acute parenteral administration of barium compounds to animals has resulted in death. Rate of administration, total dose, species, and individual differences are all factors affecting the ability of barium and its compounds to cause death. Major symptoms leading to death are hypokalemia (Jalinski et al. 1967 Roza and Berman 1971 Schott and McArdle 1974), muscle paralysis (Roza and Berman 1971 Schott and McArdle 1974), cardiorespiratory failure (Cove and Snyder 1974 Roza and Berman 1971), and convulsions (Segreti... 

Acute intravasation of barium sulfate into the circulatory system of an adult female patient following a barium enema procedure caused the compound to be deposited in blood vessels throughout the body, including the lungs, and resulted in respiratoryfailure (Cove and Snyder 1974). Acute parenteral administration of barium compounds to animals has been shown to result in paralysis of the respiratory muscles (Roza and Berman 1971). Similar respiratory paralysis is frequently encountered in cases of acute exposure in humans and animals by ingestion or inhalation. Intratracheal administration of barium sulfate into rat lungs produced a mild inflammatory reaction (Huston et al. 1952). Barium sulfate could not be removed by either polymorphonuclear leukocytes or monocytes. A tissue reaction followed however, no fibrosis was observed. Since this mode of entry is similar to inhalation, these results may be significant for cases of inhalation exposure. 

Barium sulfate is used to visualize the GI tract.105 Barium sulfate should be avoided in a patient with GI obstruction. It is insoluble and nontoxic but is a soluble compound, which is toxic and may lead to death. Constipation may be detected on oral and rectal administration, and is remedied if a large amount of water is given to the patient. A barium sulfate enema causes electrocardiogram abnormalities. Pneumonitis or granuloma formation are reported during accidental aspiration into lungs. Hypersensitivity reactions also have been reported.106... 

She could slightly warm the enema (e.g. in a cup of warm water) before administration. 

The mainstays of botulism therapy include ventilatory support as well as the administration of botulinum antitoxin. Botulinum antitoxin is a trivalent, equine antitoxin that provides antibodies to botulinum toxin Types A, B, and E. It acts only against unbound toxin and therefore its efficacy is greatest early in the patient s clinical course. Cathartics and enemas have also been recommended for elimination of botulinum toxin from the GI tract. Antibiotics are not recommended except for the treatment of secondary infectious complications... 

In hyperkalaemia, oral administration or retention enemas of a polystyrene sulphonate resin may be used. A sodium phase resin (Resonium A) should obviously not be used in patients with renal or cardiac failure as sodium overload may result. A calcium phase resin (Calcium Resonium) may cause hypercalcaemia and should be avoided in predisposed patients, e.g. those with multiple myeloma, metastatic carcinoma, hyperparathyroidism and sarcoidosis. Enemas should be retained for as long as possible, although patients rarely manage for... 

Enemas These are available as solutions (aqueous or oily) as well as suspensions for rectal administration of drugs for cleaning, diagnostic, or therapeutic effect. Lotions These are available as solutions and suspensions to be applied topically without friction. They may either contain humectant, so that moisture is retained on the skin after application, or alcohol, which evaporates quickly imparting a cooling sensation to the skin. 

Electrocardiographic changes have been recorded during administration of barium enemas and could represent a hazard in cases of cardiac disease (2-4). 

---