Please check your internet connection and try again.
# Sodium phosphate enema (e.g., Fleet Enema)
## Overview
A hyperosmotic saline laxative causing osmotic fluid shifts into the colon, stimulating evacuation. Each 118 mL (delivered volume) usually contains 19g monobasic sodium phosphate and 7g dibasic sodium phosphate.
## Primary Indications
Treatment of occasional constipation or bowel cleansing before rectal examinations.
## Adult Dosing
* **Standard dose:** 118 mL (one ready-to-use bottle) administered rectally as a single dose.
* **Maximum:** Do not exceed one dose per 24 hours.
## Pediatric Dosing
* **12 years and older:** Same as adult (118 mL).
* **2 to 11 years:** 59 mL (pediatric-sized bottle).
* **Under 2 years:** Not recommended.
* *Note:* Always confirm age-appropriate product labeling; improper use in pediatric patients can lead to severe electrolyte toxicity.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Avoid in patients with chronic kidney disease (CKD) due to risk of hyperphosphatemia, hypocalcemia, and hypernatremia.
* **Hepatic Impairment:** No specific adjustment, but use caution if ascites or fluid retention is present.
## Contraindications
* Hypersensitivity to sodium phosphates.
* Known megacolon, bowel obstruction, or imperforate anus.
* Active inflammatory bowel disease (e.g., ulcerative colitis).
* Congestive heart failure (due to sodium load).
* End-stage renal disease.
## Adverse Effects
* **Common:** Rectal irritation, abdominal pain, cramping, nausea.
* **Serious:** Severe electrolyte disturbances (hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia), dehydration, metabolic acidosis, acute kidney injury (nephrocalcinosis), and rectal mucosal injury.
## Key Drug Interactions
* **Diuretics:** Increased risk of dehydration and electrolyte imbalances.
* **Calcium Channel Blockers:** Potential for enhanced hypocalcemic effects.
* **Nephrotoxic drugs (NSAIDs, ACE inhibitors/ARBs):** Combined use may heighten the risk of acute phosphate nephropathy.
## Monitoring
* Baseline and follow-up serum electrolytes (phosphate, calcium, sodium, potassium) in high-risk patients.
* Renal function (BUN/SCr).
* Volume status (monitor for signs of dehydration/hypovolemia).
## Clinical Pearls
* **Administration:** Patient should be in the left lateral decubitus position (Sims' position). Do not force the enema tip against resistance to avoid rectal perforation.
* **Safety Warning:** Deaths have occurred in children and patients with renal failure due to electrolyte imbalances. Never exceed the recommended dose.
* **Local Protocols:** Institutional protocols for bowel preparations vary significantly; always verify if a sodium phosphate enema is preferred over polyethylene glycol-based osmotic laxatives for specific patient populations.
***
*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional guidelines, and package inserts before administration.*
