Over the counter does not equal safe

In a surprising paper published in the Archives of Internal Medicine, doctors from Israel report on a series of 11 patients who suffered complications from the use of phosphate enemas. 8 of them just used the standard, one-time 250 mL enema dose, with the other three using larger volumes. All of the patients suffered kidney damage, with 2 requiring dialysis, and 5 of them died. While there are many ways to alleviate constipation, the authors caution that perhaps phosphate enemas should only be used in patients who are otherwise relatively healthy. I would tend to agree, as I see patients with heart failure and the sodium load in some enemas has been reported to cause water retention and acute heart failure. The other important message that I think should be drawn from this report is the reminder that just because something is available at the drugstore without a prescription, it can still be dangerous. The same goes for herbs, supplements, and concoctions that are billed as "natural".