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# Sodium Phosphate Enema (e.g., Fleet Enema)
## Overview
A hypertonic saline osmotic laxative containing monobasic sodium phosphate and dibasic sodium phosphate. It attracts water into the colon, inducing bowel evacuation via distension and peristalsis.
## Primary Indications
Treatment of occasional constipation and bowel cleansing prior to diagnostic or surgical procedures.
## Adult Dosing
* **Constipation:** 118 mL (one ready-to-use bottle) administered rectally as a single dose per 24 hours.
* **Bowel Prep:** As directed by procedural protocol; usually 118 mL administered 1–2 times prior to procedure.
## Pediatric Dosing
* **Children 2 to 12 years:** 59 mL (pediatric size) administered rectally as a single dose per 24 hours.
* **Children < 2 years:** **Contraindicated.** Safety and efficacy not established; high risk of severe electrolyte disturbances.
## Dose Adjustments
* **Renal Impairment:** Exercise extreme caution. High risk of hyperphosphatemia, hypocalcemia, and hypernatremia.
* **Hepatic Impairment:** No specific adjustment, but monitor for fluid/electrolyte imbalances.
## Contraindications
* Hypersensitivity to sodium phosphates.
* Congestive heart failure or clinically significant renal impairment (due to phosphate/sodium load).
* Megacolon, bowel obstruction, or imperforate anus.
* Patients with suspected inflammatory bowel disease or history of bowel perforation.
* Age < 2 years.
## Adverse Effects
* **Common:** Abdominal pain, cramping, nausea, anal irritation.
* **Serious:** Dehydration, hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, metabolic acidosis, and symptomatic tetany (secondary to hypocalcemia/hypophosphatemia). Rectal mucosal damage or perforation if inserted improperly.
## Key Drug Interactions
* **Diuretics/ACE Inhibitors/ARBs:** Increased risk of renal impairment or electrolyte shifts.
* **Calcium Channel Blockers:** Potential for worsening hypocalcemic side effects.
* **NSAIDs:** Use with caution; may increase risk of nephrotoxicity.
## Monitoring
* Monitor for signs of dehydration (thirst, decreased urine output).
* In vulnerable populations: Check serum electrolytes (phosphate, calcium, sodium, potassium) if signs of toxicity emerge or if multiple doses are administered.
* Monitor for signs of hypocalcemic tetany (muscle spasms, paresthesias).
## Clinical Pearls
* **Positioning:** Patient should be in the lateral decubitus position (left side) with knees flexed during administration.
* **Administration:** Lubricate the nozzle before insertion. Do not force the enema; stop if resistance is felt.
* **Efficacy:** Effectiveness is generally expected within 2 to 15 minutes.
* **Safety Warning:** Deaths have occurred in pediatric patients and elderly adults due to electrolyte imbalances caused by excessive dosing or inappropriate use in patients with renal dysfunction. Never exceed the recommended frequency.
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*Disclaimer: This information is for educational purposes only. Always verify doses, contraindications, and drug interactions against current prescribing information, institutional protocols, and clinical guidelines before administration.*
