Symptomatic Hyperphosphataemia Following Phosphate Enema in A Healthy Adult

for more training and widespread availability of gastrostomy replacement tubes. Replacement gastrostomy tubes are expensive and it is impractical to have every size and make available. In addition, attending staff need to know what size of PEG tube was removed / dislodged in order to replace a similar size and unfortunately this information is not always available. All attending professionals caring for patients in the community following PEG tube insertion have a responsibility to be fully informed and competent. It is our current practice that all patients being discharged with new PEG tubes are given a replacement gastrostomy tube and instructions as to what to do if the original tube becomes dislodged. This advice includes bringing it with them to Accident and Emergency unit if a hospital visit is required. Nutrition Nurse specialists in our trust send a letter to the District nursing services which also includes the requisition numbers for replacement gastrostomy tubes and the request that these are ordered and available in the patients' homes. Contact details of the Nutrition Nurse specialist are also contained in the documentation. We would dispute that our comments regarding the ability of District Nurses to replace gastrostomy tubes are inappropriate since this " needs to be performed in a hospital environment ". Ideally, trained professionals in the community are suitably situated to replace gastrostomy tubes to avoid unnecessary trips to Accident and Emergency units. The letters have identified several areas for possible service development. We greatly appreciate the comprehensive service provided in the community by our District Nursing colleagues and others. symptomatic hyperphosphataemia FollowinG phosphate enema in a healthy adult Editor, Adequate colonic cleansing is essential for accurate and safe colonic procedures 1. Common preparations for cleansing include diet in combination with a cathartic agent (stimulants), gut lavage, and phosphate preparations (osmotics). Phosphate preparations offer an attractive alternative due to smaller volumes required for ingestion. We report an unusual case of acute hyperphosphataemia following the administration of a phosphate enema. case report: A 79 year lady with a six month history of lower abdominal cramps and diarrhoea including mucous per rectum underwent flexible sigmoidoscopy. She had taken one sachet of picolax (10mg sodium picosulfate) as bowel preparation the night before and reported minimal effect. As such she received a single phosphate enema at 09.30. This contained 30.8g of sodium phosphate in 118ml delivered by a standard rectal tube. She became unwell within …