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J Emerg Med. 2015 Jun;48(6):667-70. doi: 10.1016/j.jemermed.2015.01.035. Epub 2015 Apr 4.

Safety and efficacy of milk and molasses enemas in the emergency department.

Author information

1
Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California.

Abstract

BACKGROUND:

Increased scrutiny is occurring from regulatory agencies about the use of nonsterile enema preparations in the emergency department (ED) for constipation. This includes the "off-label" use of milk and molasses (M&M) enemas, as there are no reported data in the medical literature to determine safety and efficacy.

OBJECTIVES:

To evaluate the success and complication rates of administering M&M enemas in the ED.

METHODS:

This was a structured retrospective study at two EDs over 8 years. Primary success was defined as the patient having a bowel movement. Secondary measures of success included improved pain score by 2 or more points or lowering of a heart rate initially over 100 beats/min by 20 or more beats/min. Complications included: hemodynamic compromise, increased pain, electrolyte disturbances, bacteremia, bowel perforation, rectal pain or bleeding, cardiac dysrhythmias, anaphylaxis, electrolyte disturbances, dizziness or syncope, or hospital admission for issues surrounding enema.

RESULTS:

There were 2013 enemas given, of which 261 were M&M enemas; 214 were given alone. Success rates defined only as bowel evacuation for M&M enemas alone were 87.9% (188/214) and, when used after other treatment failures, were 82.4% (28/34) successful. Five additional patients improved with the secondary measures (90.2% success). There were 8/261 complications (3.1%), of which four had an increased heart rate, two had decreased blood pressure, one had an increased pain score, and one subsequently developed a fever.

CONCLUSION:

M&M enemas have a low complication rate when used in the ED.

KEYWORDS:

constipation; enema; nausea/vomiting; resource utilization

PMID:
25850633
DOI:
10.1016/j.jemermed.2015.01.035
[Indexed for MEDLINE]

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