Please check your internet connection and try again.
# Sodium Phosphate Enema
## Overview
A hyperosmotic saline laxative containing monobasic sodium phosphate and dibasic sodium phosphate. It attracts water into the colon, distending the bowel and stimulating evacuation.
## Primary Indications
* Relief of occasional constipation.
* Bowel evacuation prior to rectal examinations or endoscopic procedures.
## Adult Dosing
* **Standard dose:** 118 mL (one ready-to-use bottle) administered rectally as a single dose.
* **Maximum:** Do not exceed one dose in a 24-hour period.
## Pediatric Dosing
* **Children 2 to under 5 years:** Not recommended (safety not established; high risk of electrolyte toxicity).
* **Children 5 to under 12 years:** 59 mL (pediatric size ready-to-use bottle) administered rectally as a single dose.
* **Children 12 years and older:** 118 mL (adult size ready-to-use bottle) administered rectally as a single dose.
## Dose Adjustments
* **Renal Impairment:** Contraindicated or use with extreme caution due to the risk of severe hyperphosphatemia, hypocalcemia, and systemic electrolyte shifts.
* **Electrolyte disturbances:** Avoid use in patients with pre-existing electrolyte imbalances.
## Contraindications
* Known hypersensitivity to sodium phosphates.
* Symptoms of appendicitis or acute surgical abdomen.
* Fecal impaction or bowel obstruction.
* Megacolon (congenital or acquired).
* Congestive heart failure or severe renal impairment.
* Perforated bowel or inflammatory bowel disease (active colitis).
## Adverse Effects
* **Common:** Rectal irritation, anal burning, abdominal cramping.
* **Serious (Electrolyte Toxicity):** Hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, metabolic acidosis, dehydration, and acute kidney injury (nephrocalcinosis).
## Key Drug Interactions
* **Nephrotoxic agents:** NSAIDs, ACE inhibitors, ARBs (increased risk of acute kidney injury).
* **Diuretics:** Combined with laxative effect can exacerbate electrolyte and fluid loss.
* **Calcium channel blockers:** Risk of increased hypocalcemia.
## Monitoring
* Monitor for signs of dehydration (thirst, decreased urine output).
* In vulnerable populations: Serum electrolytes (phosphate, calcium, sodium, potassium) and renal function (BUN/SCr).
* Discontinue use if rectal bleeding occurs or if there is no bowel movement within 30 minutes of administration.
## Clinical Pearls
* **Administration:** Patient should lie on the left side with knees bent (Sims' position). Gently insert the lubricated enema tip and squeeze the bottle slowly.
* **Risk:** Systemic absorption is significant in patients with impaired mucosal integrity. Avoid repeated or frequent dosing; use is intended for acute, short-term relief only.
* **Pediatric Warning:** Children are at a much higher risk of "phosphate poisoning" (symptomatic hypocalcemia/hyperphosphatemia) even with standard doses.
***
**Disclaimer:** This information is for educational purposes only. Always verify doses, contraindications, and patient-specific safety profiles against the most current institutional protocols or official FDA-approved prescribing information before administration.
