Sodium Phosphate Enemas: How to Kill Cats, Cause Cardiac Arrest, and Cure Eye Rolling at Stanford

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To the Editor.— The continuing reports of intoxication following administration of commercial hypertonic sodium phosphate enema solution in both the human1,2and veterinary3literature and the recent comment on the lack of animal studies of sodium phosphate enema intoxication prompt me to write. In a recent study,4we systematically evaluated alterations in acid-base, fluid, and electrolyte balance after administration of hypertonic sodium phosphate enemas to normal adult cats. Study.— Ten awake cats, in whom arterial catheters had been previously implanted, were divided into two groups. Group A received 60 mL (mean dose, 18 mL/kg) of hypertonic sodium phosphate enema solution and group B received 120 mL (mean dose, 32 mL/kg) of hypertonic sodium phosphate enema solution, both with five minutes' forced retention. Abnormalities, noted as early as 15 minutes following administration of enema solution, included severe hyperphosphatemia, mild hypernatremia, hyperglycemia, hypocalcemia, lactic acidosis with an increased anion